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Would insurance reimburse later?

tennessee1031

By tennessee1031, in Insurance & Financing

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tennessee1031    0

tennessee1031
Posted

It looks like I'll have to pay out of pocket for my surgery since as of right now, my primary carrier (Aetna) nor my secondary (Tricare) cover the procedure. It'll probably come to pass that either or both will start to cover the procedure soon but I'm not holding my breath. I, like many could easily say "I don't have the money" and put off the surgery and put off my health at the same time. I guess this means a trip to the credit union to borrow the money to get the procedure done.

My question is this: Does anyone know if we pay out of pocket and later the insurance covers VSG, is reimbursement ever possible?

Thanks in advance:)))

Kimberly

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i1Linda    15

i1Linda
Posted

Hi Kimberly,

Sorry to say, working in the medical field, I have never seen an insurance company pay for a procedure retroactively. It's either covered on day of procedure, or it's not. I am definitely not an expert on this however, so maybe someone else can chime in.

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artteacher698    0

artteacher698
Posted

I asked the surgeon that i intended to use in NJ...he said NOPE...so I went to Dr. Aceves and could'nt be happier! I had no interest in wasting time fighting with the insurance and waiting for the policy to chance! Once I had made up my mind...it was just TIME!

kris

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Tiffykins    673

Tiffykins
Posted

I'm an insurance agent, and have never seen a claim be paid for an excluded procedure retroactively.

Tricare does cover the procedure at MTFs that offer the procedure just to let you know that is how I had my revision covered 100% by Tricare Prime.

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tennessee1031    0

tennessee1031
Posted

Thanks so much everyone!! Tiffykins- My nearest base is Ft. Campbell. I called and they aren't doing it anymore, but I'm on a mission to call them ALL on Monday morning. THANKS:)

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Tiffykins    673

Tiffykins
Posted

Thanks so much everyone!! Tiffykins- My nearest base is Ft. Campbell. I called and they aren't doing it anymore, but I'm on a mission to call them ALL on Monday morning. THANKS:)

I think there is an MTF that is in Kentucky that is offering and covering the sleeve.

Keep us posted ! ! !

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tennessee1031    0

tennessee1031
Posted

Thanks Tiffy. I did call Ft. Campbell last week and the gent said they only do LB and RYN. I think they did a trial of them before prob to test for tricare, I dunno. I wish they still did. Maybe they do and the guy didn't know what I was referring to? Hummm...

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christina@MIA    12

christina@MIA
Posted

I'm an insurance agent, and have never seen a claim be paid for an excluded procedure retroactively.

Tricare does cover the procedure at MTFs that offer the procedure just to let you know that is how I had my revision covered 100% by Tricare Prime.

Hi Tiffykins,

I'm just getting started with researching VSG. I also have Tricare and live in FLORIDA. I see you know your stuff when it comes to Tricare and VSG. Please give me direction where to start. I live in Miami and have Tricare Prime. Can I just go to a MTF? Also I am 5ft4 and weigh 215. Do I have a chance? Im tried of the struggle and feeling older than I am.

Please Help. Here is my email anthony31504@aol.com

Thank you - Christina

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Tiffykins    673

Tiffykins
Posted

Hi Tiffykins,

I'm just getting started with researching VSG. I also have Tricare and live in FLORIDA. I see you know your stuff when it comes to Tricare and VSG. Please give me direction where to start. I live in Miami and have Tricare Prime. Can I just go to a MTF? Also I am 5ft4 and weigh 215. Do I have a chance? Im tried of the struggle and feeling older than I am.

Please Help. Here is my email anthony31504@aol.com

Thank you - Christina

Email sent.

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Go To Topic Listing Insurance & Financing

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    • Alisa_S

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      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
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