Jump to content
×
Are you looking for the BariatricPal Store? Go now!

Self-pay and post-op problems



Recommended Posts

If your insurance states they don't cover any wls then they don't cover any wls related complications either. Even if you code due to complications. They don't even have to pay if it's a medical necessity. My expenses hit $100,000 and insurance denied any coverage.

Check with your insurance company if you can't cover expenses from a possible complication. If you can afford it don't inform them at all or you'll be red flagged and they will scrutinize all your incoming medical billing.

Share this post


Link to post
Share on other sites

If your insurance states they don't cover any wls then they don't cover any wls related complications either. Even if you code due to complications. They don't even have to pay if it's a medical necessity. My expenses hit 100' date='000 and insurance denied any coverage.

Check with your insurance company if you can't cover expenses from a possible complication. If you can afford it don't inform them at all or you'll be red flagged and they will scrutinize all your incoming medical billing.[/quote']

My insurance DOES cover WLS. I'm just not sure I'll be approved.

Share this post


Link to post
Share on other sites

Oh sorry I misunderstood. I don't see how thy can deny coverage for complications then. Good luck :D

Share this post


Link to post
Share on other sites

I was self pay and part of the price I paid to my doctor covered insurance that would cover any complications up to 3 months after the surgery I believe.

Share this post


Link to post
Share on other sites

I was self pay and part of the price I paid to my doctor covered insurance that would cover any complications up to 3 months after the surgery I believe.

That's good to know! Lets hope that's a standard for all bariatric surgeons.

Share this post


Link to post
Share on other sites

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...

Personally, with my experience with insurance companies, I dont think they have the capability of putting those bits of data together. They will look at your BMI, any chronic conditions and then either approve or try to deny depending on the insurance company. I think you timed it perfectly, unless of course you are planning to have another child soon.

alex

Share this post


Link to post
Share on other sites

Personally' date=' with my experience with insurance companies, I dont think they have the capability of putting those bits of data together. They will look at your BMI, any chronic conditions and then either approve or try to deny depending on the insurance company. I think you timed it perfectly, unless of course you are planning to have another child soon.

alex[/quote']

Alex, I love your optimism and pray you're right. As far as I'm concerned, I don't plan on having any more children. Of course God may have other plans! LOL Two kids, two parents - at this point they don't outnumber us...

Share this post


Link to post
Share on other sites

I did not qualify for covered WLS under my insurance plan (lowish BMI and no co-morbids) so according to three different conversations with the ins.co., complications for self-pay (they called it elective surgery) would not be covered either. Just for fun, I asked about non-covered plastic surgery complications and same deal: no coverage.

It's the biggest concern self-payers have.

Share this post


Link to post
Share on other sites

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

This is not necessarily accurate. My insurance excluded WLS specifically, regardless of any circumstance. They do, however, cover emergency and follow up care, as necessary. If I had had an emergency post-op, they would have covered whatever care was needed.

It is a question I specifically asked. My PCP even helped me find a bariatric surgery practice that was willing to treat me, if I had any need, once I was home.

Luckily, it hasn't been an issue. But it eased my mind knowing I would be care for, should I need it.

~Kat

Share this post


Link to post
Share on other sites

This is not necessarily accurate. My insurance excluded WLS specifically' date=' regardless of any circumstance. They do, however, cover emergency and follow up care, as necessary. If I had had an emergency post-op, they would have covered whatever care was needed.

It is a question I specifically asked. My PCP even helped me find a bariatric surgery practice that was willing to treat me, if I had any need, once I was home.

Luckily, it hasn't been an issue. But it eased my mind knowing I would be care for, should I need it.

~Kat[/quote']

Kat how did you go about figuring this out? I plan to be a self pay also because my insurance doesn't cover wls. I would like to know if they cover anything related to it afterwards.

Share this post


Link to post
Share on other sites

Kat how did you go about figuring this out? I plan to be a self pay also because my insurance doesn't cover wls. I would like to know if they cover anything related to it afterwards.

I talked to my HR and they contacted the insurance company to clarify. :)

~Kat

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • buildabetteranna

      I have my final approval from my insurance, only thing holding up things is one last x-ray needed, which I have scheduled for the fourth of next month, which is my birthday.

      · 0 replies
      1. This update has no replies.
    • BetterLeah

      Woohoo! I have 7 more days till surgery, So far I am already down a total of 20lbs since I started this journey. 
      · 1 reply
      1. NeonRaven8919

        Well done! I'm 9 days away from surgery! Keep us updated!

    • Ladiva04

      Hello,
      I had my surgery on the 25th of June of this year. Starting off at 117 kilos.😒
      · 1 reply
      1. NeonRaven8919

        Congrats on the surgery!

    • Sandra Austin Tx

      I’m 6 days post op as of today. I had the gastric bypass 
      · 0 replies
      1. This update has no replies.
    • RacMag  »  bhogue925

      Hi, I’m new here. I’m currently on the liver shrinking diet. So far so good, but I have to say I haven’t found a protein shake I like. Anyone have any suggestions please? My surgery date is September 17th. 
      · 2 replies
      1. BlondePatriotInCDA

        Fairlife Core are by far the best. They taste just as they are - chocolate milk. You can either get the 26 grams or the 42 grams (harder to find and more expensive). For straight protein look at Bulksuppliments.com ..they have really good whey proteins and offer auto ship plus they test for purity. No taste or smell...

      2. BlondePatriotInCDA

        Fairlife has strawberry, vanilla and of course chocolate. No more calories than other protein drinks. Stay away from Premiere, they're dealing with lawsuits due to not being honest about protein content.

  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×