post op coverage if self pay

[miz z 0]

I have Harvard Pilgrim and will likely have to self pay -- BMI 37 w/ 1 co-morbidity of sleep apnea. My question is if I have the sleeve self pay and anything goes wrong post surgery, will insurance cover any compliacations if they didn't cover the sleeve surgery in the first place?

[Foxbins 625]

Call them and ask. My insurance said they would cover emergency treatment (like if I had a leak) and that was what I was concerned about since I had surgery in Mexico. My PCP has also been supportive and agreed to do the 3 month follow-up blood work and upper GI.

[miz z 0]

Thank you! I will do as you suggest, but I'm somewhat releived.

I have Harvard Pilgrim and will likely have to self pay -- BMI 37 w/ 1 co-morbidity of sleep apnea. My question is if I have the sleeve self pay and anything goes wrong post surgery, will insurance cover any compliacations if they didn't cover the sleeve surgery in the first place?

[lowkee00 1]

I have Harvard Pilgrim and will likely have to self pay -- BMI 37 w/ 1 co-morbidity of sleep apnea. My question is if I have the sleeve self pay and anything goes wrong post surgery, will insurance cover any compliacations if they didn't cover the sleeve surgery in the first place?

I am going to post my whole story in the next week or so, but to sum it up quickly, I had the sleeve in Mexico, had a leak 3 months later, spent 5 months in the hospital with sepsis, 2 in a coma. My wife was told first night I would most likely die. Insurance DENIED all bills, 1.5 million to date. If I would have had the surgery in the US and had problems, they carry a separate insurance policy to cover problems after the fact. Keep this in mind as you pay the less expensive surgeries out of the country. As of today, I am bankrupt, lost my home and was denied even physical therapy to help me walk again after serious dropfoot and muscle atrophy.

[KabinKitty 10]

Wow LowKee, I'm so sorry to hear about what you had to go through. Isn't it very unusual to have a leak that far out? I fear that alot of people having this surgery don't take into account the fact that it is a major surgery.

From what I read in my insurance policy (it's Anthem BC/BS PPO-Blue Access) if I self pay for a surgery that they don't cover or approve, then they will not pay for any complications that arise after.

It's scary what you have gone through. That is why I waited until Anthem would pay for my sleeve.

[wareagle40 3]

Wow LowKee, I'm so sorry to hear about what you had to go through. Isn't it very unusual to have a leak that far out? I fear that alot of people having this surgery don't take into account the fact that it is a major surgery.

From what I read in my insurance policy (it's Anthem BC/BS PPO-Blue Access) if I self pay for a surgery that they don't cover or approve, then they will not pay for any complications that arise after.

It's scary what you have gone through. That is why I waited until Anthem would pay for my sleeve.

My BCBS said they would not pay for any weight loss surgery or any complications arising from weight loss surgery.

[MINI-Me 196]

Are you having surgery here in the US? If so, ask about the BLISS program - it covers WLS complications not covered by insurance.

Without BLISS, my surgeon's costs were covered 100% for complications, but I would have been on the hook for hospital costs.

[lowkee00 1]

Wow LowKee, I'm so sorry to hear about what you had to go through. Isn't it very unusual to have a leak that far out? I fear that alot of people having this surgery don't take into account the fact that it is a major surgery.

From what I read in my insurance policy (it's Anthem BC/BS PPO-Blue Access) if I self pay for a surgery that they don't cover or approve, then they will not pay for any complications that arise after.

It's scary what you have gone through. That is why I waited until Anthem would pay for my sleeve.

That's exactly what I have, Anthem BC/BS PPO Blue Access

[miz z 0]

Are you having surgery here in the US? If so, ask about the BLISS program - it covers WLS complications not covered by insurance.

Without BLISS, my surgeon's costs were covered 100% for complications, but I would have been on the hook for hospital costs.

I couldn't find any info on the BLISS program. What is it? Any details you could share would be super! Many thanks.

[MINI-Me 196]

Here is a link to the company ... http://www.bliscompany.com/intro/about-us.html

[Tina293 0]

I am going to post my whole story in the next week or so, but to sum it up quickly, I had the sleeve in Mexico, had a leak 3 months later, spent 5 months in the hospital with sepsis, 2 in a coma. My wife was told first night I would most likely die. Insurance DENIED all bills, 1.5 million to date. If I would have had the surgery in the US and had problems, they carry a separate insurance policy to cover problems after the fact. Keep this in mind as you pay the less expensive surgeries out of the country. As of today, I am bankrupt, lost my home and was denied even physical therapy to help me walk again after serious dropfoot and muscle atrophy.

So sorry to hear of your troubles lowkee. I'm just wondering what surgeon you went to for your VSG

[lowkee00 1]

So sorry to hear of your troubles lowkee. I'm just wondering what surgeon you went to for your VSG

It should be listed at the bottom of my last post.

Dr. Aceves, March 15, 2010

[kgremmy 36]

I am so sorry to hear of what happened to you.