Help with Surgery / Insurance POST Surgery Question

[Adam1980 0]

Hi,

I want to introduce myself, I'm Adam. I've been lurking on this site and the mobile version for a while and I have to say it's an excellent resource. Every time I google something about the band, LBT always comes up. So I have a few questions and mods/admin I apologize if I'm posting this in the wrong place. My wife is strongly considering this surgery. We have Athem BCBS's Blue Access (we live in Kentucky). In our policy there is an exclusion for band surgeries:

For bariatric surgery, regardless of the purpose it is proposed or performed. This includes Roux-en-Y (RNY), Laparoscopic gastric bypass surgery or other gastric bypass surgery (surgical procedures that reduce stomach capacity and divert partially digested food from the duodenum to the jejunum, the section of the small intestine extending from the duodenum), or Gastroplasty, (surgical procedures that decrease the size of the stomach), or gastric banding procedures.

Complications directly related to bariatric surgery that result in an Inpatient stay or an extended Inpatient stay for the bariatric surgery, as determined by Us, are not covered. This exclusion applies when the bariatric surgery was not a Covered Service under this Plan or any previous Anthem plan, and it applies if the surgery was performed while the Member was covered by a previous carrier/self funded plan prior to coverage under this certificate. Directly related means that the Inpatient stay or extended Inpatient stay occurred as a direct result of the bariatric procedure and would not have taken place in the absence of the bariatric procedure.

This exclusion does not apply to conditions including: myocardial infarction; excessive nausea/vomiting; pneumonia; and exacerbation of co-morbid medical conditions during the procedure or in the immediate post operative time frame.

We are not worried about the cost of the surgery. My wife has saved money and we probably are going to pay for most of the surgery in cash, financing only about 25% of it. My deep concerns/questions are the following:

1. What are the types of complications that arise from banding and do they require a hospital stay

2. We don't work for a large company so a band is a pre-existing condition and will follow her everywhere with every provider, is that right?

3. Do you recommend a course of action or a plan that we could explore? Our problem is that she is overweight and insurance companies WON'T cover her. Should we consider a state alteranative which one? I'm clueless

4. How long until our insurance does not consider it pre-existing.

What are your recommendations. Are my concerns valid, should I fear the complications? What complications did YOU have and what was the financial cost if you were a self pay?