Hi all,

I was denied by Aetna in August and am in the appeal process with Lindstrom Advocacy. If that doesn't gain me approval I am thinking of doing self-pay. I was curious what happens if you self pay and have complications down the road. Do you have to pay to get the band removes/fixed? I'm only 20 and know that complications can occur with pregnancy, time, etc and I wouldn't want to pay the money for the surgery to have to pay again to fix it in a few years. Do any insurances that don't cover the initial surgery but do cover complications?? Please let me know, any feedback would be great!!

Thanks

Mandy

I have heard of some Dr's selling complication insurance to self pay patients. If you do go that route, you can ask your surgeon if they have that available.

Otherwise, I would assume you would pay out of pocket.

Hi all,

I was denied by Aetna in August and am in the appeal process with Lindstrom Advocacy. If that doesn't gain me approval I am thinking of doing self-pay. I was curious what happens if you self pay and have complications down the road. Do you have to pay to get the band removes/fixed? I'm only 20 and know that complications can occur with pregnancy, time, etc and I wouldn't want to pay the money for the surgery to have to pay again to fix it in a few years. Do any insurances that don't cover the initial surgery but do cover complications?? Please let me know, any feedback would be great!!

Thanks

Mandy

If you don't mind me asking, why did Aetna deny you? I was denied by them last week as well...

The only time I've heard of insurance covering complications for self pay patients is if it's a life or death situation. Otherwise, typically speaking, they won't pay for anything band related, complications or not.

If you don't mind me asking, why did Aetna deny you? I was denied by them last week as well...

@Brandyrn73 They denied me for not showing a high enough weight for 2 years. I used Jenny Craig records and because I had lost weight (even though I gained it back) they denied me. I am appealing the decision through Lindstrom Advocacy! Direct Message me if you have any questions about it. Its a free law agency that defends on your behalf. Good Luck!

I would keep appealing until you run out of options. My work insurance didn't cover my surgery so I went with United Medical Credit. They were helpful and found me a payment plan i could work with. I do hope you get your insurance coverage but if not have a look at their site. http://www.unitedmedicalcredit.com/

Thinking of you and wishing all the best.: )

I'm surprised that your surgeon wasn't more on top of this. My surgeon got me a second diagnosis for sleep apnea so that they insurance would cover lap band.

They didn't even submit it to the insurance until my study came back positive with MILD APNEA. After submission of a well documented file I was approved 3 days later.

Doctors know that low BMI is a sure reject by the insurance companies. But low BMI with sleep apnea is a sure approval.

And btw if you are overweight you HAVE some sleep apnea, no doubt.

Keep us informed!