So if you have to have the band removed does insurance cover it? I had surgery in Mexico and my insurance wouldn't cover it. I wondered if I had to have it out if Insurance would cover it.

If it was an emergency would they cover it?

Anyone have answers??

Thanks Kathy

Hi,

Well I had my band removed on Jan.24 due to erosion and my insurance is going to pay. It cost about 39,000 to have the thing removed with the hospital stay and all. I also had my band placed in MX. I live in Oregon and have pacific source insurance. I dont about there insurances. Hope this help some. Tracey

I was told that if it is an emergency then the insurance has to cover it. Not sure if it is true..but that is what I was told!

I have Regence Blue Shield. I went to Mexico for my band, self-pay. Now I have to have it out due to erosion. Regence says they won't pay for the removal surgery because they don't cover anything related to weight.

If insurance companies have to pay for emergency procedures, I wonder how much erosion would qualify as an emergency?

Tracey, I have a couple of questions for you:

1. Does your insurance normally cover weight related surgeries?

2. Did you call them before your emergency band removal, or just go for it?

I'm trying to figure out how to do this. Anyone have any experience with this?

Hi Lena,

I will try to make this short for you

I had a baby last April 2005 2 weeks after my c-section my port site filled up with fluid so I had went to see a Dr. neal in washington in Aug. to have it checked and he said that the port needed moved and the area cleaned so it took his office several months to see if my insurance would cover any of it. My insurance said that they would cover the part of having the port removed and the area cleaned and that was all no part of the new port or anything like that so I said okay how much will be my part there quote total was 5000 so how much of that do I have to pay I have not heard back from them yet the last time I talked to them was in DEC. 2005 and the office person Nancy said go back to MX so I went to see another band Dr. in Coos bay Oregon in Dec. he said I needed a Endo so in the mean time I had his office send papers to my insurance because at this time I did not know I was eroded I just thought I needed the site cleaned my port moved so my insurance said the same thing about what they would pay for also they would cover the Endo except for my co-pay deductable okay so on Jan.23rd I had the endo he said I was more than 60% eroded so it had to come out the next day. I had talked to my insurance before hand and asked them if it has to come out would they pay I had been given a nurse case manager that was handling my claim and she told me if it had to come out she would go to bat forme to get them to pay for it. After we left the Dr. office we went to a hotel to stay the night and my husband called the case manager left a message said it has to come out ASAP tomorrow I was in the hospital for 2 days before we got home it is a 3 hour drive to the Dr. I had a approval letter in the mail saying that they would pay for it. I got the paper work this week that they paid all but my 300.00 deductable and 2000.00 that is my out of pocket cap for the year to bad it did not come out in 2005 because I had already paid 2300.00 to have my daughter.. Get your Dr. office to send in a claim push it as for a case manager PRAY alot. Good Luck I hope this helps, Tracey

My band removal was covered with my insurance. I only had to pay $900.

The removal surgery cost almost $22,000

If your doctor treats the removal as an emergency then your insurance should cover the removal. Ask your doctor to admit you through the ER for the band removal. That is seen as an emergency.

You know, I don't know WHAT--if anything--my doctor submitted to my insurance for the band removal part of the surgery. He DID submit for the DS and they paid him. His "program fee" (that's out of pocket for me) is $1000 more for revisions...maybe that's where he makes up the difference.

Can I ask who the Doctor was that you saw in Coos Bay? I want a endoscope and I am having a hard time getting one done. What did you

have to do to see him?

Thanks Kathy

I'm not banded yet, but I asked my dr that very question (since I'll be a self-pay) ~ Insurance won't cover to get it, will they pay to remove it if I run into problems...Dr. Jay said yes, at that point, it is considered medically necessary.

My insurance sent a denial letter for my lap band removal, calling it bariatric surgery. But, the letter also said pre-certification wasn't required for outpatient stays, which I was. So we're submitting and hoping fot the best. If they deny, I plan to fight until the bitter end because my health, and life, was being put at risk from my band-related complications.