Self-pay and post-op problems

[laffypatty 47]

Good evening!

As I get closer and closer to submitting everything to my insurance (Aetna), I fear I'll be denied. However, my husband has agreed for us to pay for the surgery regardless because he knows it means the world to me. I was very happy about the decision until this morning. My best friend, a doctor of general medicine, called and told me to make certain my insurance would cover me in the event there were post-op problems related to the surgery. Anyone have any advice/experience in this matter?

[Corky6984 134]

I have Aetna and was approved. I also had a co-worker who had the bypass and had major complications and insurance covered that and her skin removal, lift, or whatever she had done with it. She was my go-to person when I decided to take my first steps to do this a year ago. I asked her a lot since I knew she had the same insurance and everything. I don't think you'll have anything to worry about!

[laffypatty 47]

I have Aetna and was approved. I also had a co-worker who had the bypass and had major complications and insurance covered that and her skin removal' date=' lift, or whatever she had done with it. She was my go-to person when I decided to take my first steps to do this a year ago. I asked her a lot since I knew she had the same insurance and everything. I don't think you'll have anything to worry about![/quote']

Thanks for the response, Corky! I'm crossing my fingers for approval, but I have no comorbids. It's a long story. Some of my other posts explain my situation. I'm just praying that whoever reviews my case is in a really good mood that day!

[Reigo 110]

Confirm with your insurance but if they deny your surgery, post op complications are also not covered.

[mariamitani 405]

I am self paid and needed blood work done post op and once went to the ER for dehydration. My insurance covered it but I paid the co pay. I have straight medicaid in michigan. there is a potential of getting a leak or embolism post op. These are the most feared issues post op. Depending on your doc the percent of them happening is pretty low. Follow your doctors rules. at around a month post -op if your taking medications they will need to be adjusted according to your new weight and lifestyle, so youll need a doctors visit for that and blood work done anually to make sure your getting your Vitamins in. Good luck I love my sleeve

[Corky6984 134]

Thanks for the response' date=' Corky! I'm crossing my fingers for approval, but I have no comorbids. It's a long story. Some of my other posts explain my situation. <img src='http://www.bariatricpal.com/public/style_emoticons/<#EMO_DIR#>/smile.png' class='bbc_emoticon' alt='' /> I'm just praying that whoever reviews my case is in a really good mood that day![/quote']

Good luck! Mine I guess was my age and BMI, other than that, I didn't either, which I was TOTALLY shocked by!

[laffypatty 47]

Good luck! Mine I guess was my age and BMI' date=' other than that, I didn't either, which I was TOTALLY shocked by![/quote']

Corky, my current BMI is almost 43. I have a 3-month-old baby. The weight I have for 2010 is while pregnant, my 2011 weight is at my 6-week postpartum checkup, and my weight for 2012 is while pregnant. Since my insurance paid for my pregnancies, they'll know the submitted weights are while pregnant. You catch my drift? Those weights all put me at a BMI of well over 40. My no pregnancy weight in 2010 and 2012 put me at a BMI of 35 and 37, respectively. My insurance requires a comorbidity if you have a BMI of less than 40. I have none. Looks like I'm screwed either way - unless, of course, the person reviewing my file doesn't pay attention to the fact I was pregnant in '10 and '12 or at least doesn't care...

[Corky6984 134]

Gotcha! I hope everything works out! I'll send some good vibes your way!

[laffypatty 47]

Gotcha! I hope everything works out! I'll send some good vibes your way!

Thanks! I appreciate that more than you know. I want this so bad. Like many of us, I've tried everything, had great success and gained all the weight back plus some.

[Corky6984 134]

You're very welcome and I understand!

[Reigo 110]

My insurance had the same requirement and I didn't qualify either. Hopefully, they won't catch the pregnancy weights!

[Sherrischeffler 74]

I have Aetna and was approved. I also had a co-worker who had the bypass and had major complications and insurance covered that and her skin removal' date=' lift, or whatever she had done with it. She was my go-to person when I decided to take my first steps to do this a year ago. I asked her a lot since I knew she had the same insurance and everything. I don't think you'll have anything to worry about![/quote']

I have Aetna also great news

[Corky6984 134]

[Rox 200]

My insurance specifically excludes WLS. I am going to Mexico - if, god forbid, I should have any problems - I will go to my family Dr. - am hoping that nothing will go wrong - but my Dr. will take care of my post-op testing etc.

[MandaPanda 173]

Most self pay physicians build BLIS insurance into the cost which covers a few months after surgery just in case.