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Self Pay and surgery complications

HealthyRN

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HealthyRN    56

HealthyRN
Posted

I have Tricare insurance who will not pay for my surgery, I have pulled cash from my home and will be a self pay patient. My concern is, if I run into complications post surgery will Tricare pay?

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HealthyRN    56

HealthyRN
Posted

This would be after I go home, = days, weeks , months later.

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OKCPirate    5,323

OKCPirate
Posted

It depends. They should, but they sometimes they balk claiming the original provider should fix a mistake. Depends on who is doing the coding. If you look at the contracts and policies there is enough wiggle room for it to go either way. Sorry I wish you could get a clear answer, but I can't get anyone to give me a clear answer on how much an office visit is to my doctor and the IRS can't give me clear answers EVER.

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SeahawksFan    444

SeahawksFan
Posted

It does depend how the hospital or doctor codes it. I was self pay and I had to go to the ER 8 days later because I was dehydrated. I didn't have to pay for it. ;-)

~LA

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FocusOnMeNow    599

FocusOnMeNow
Posted

My Dr. required "BLIS" insurance. I had to pay an additional $2,000 policy for this which covered anything that happened 90 days out and then covered treatment of all those complications for a year. The extra expense sucked at first, but I can honestly say that you should consider going for someone who really wants to look after you beyond surgery day. Of course, I've had no complications and my surgeon was wonderful and went above and beyond in every way.

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lillingtonnc    6

lillingtonnc
Posted

Why wouldn't tricare cover your surgery? Tricare covered my surgery which I had at mtf so I was able to have sleeve.

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HealthyRN    56

HealthyRN
Posted

I do not have any co morbidities and a bmi of 35. Therefore tricare will not pay for it

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Go To Topic Listing General Weight Loss Surgery Discussions

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    • KeeWee

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      It's been 10 long years! Here is my VSG weight loss surgiversary update..
      https://www.ae1bmerchme.com/post/10-year-surgiversary-update-for-2024 
      · 0 replies
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    • Aunty Mamo

      Aunty Mamo

      Iʻm roughly 6 weeks post-op this morning and have begun to feel like a normal human, with a normal human body again. I started introducing solid foods and pill forms of medications/supplements a couple of weeks ago and it's really amazing to eat meals with my family again, despite the fact that my portions are so much smaller than theirs. 
      I live on the island of Oʻahu and spend a lot of time in the water- for exercise, for play,  and for spiritual & mental health. The day I had my month out appointment with my surgeon, I packed all my gear in my truck, anticipating his permission to get back in the ocean. The minute I walked out of that hospital I drove straight to the shore and got in that water. Hallelujah! My appointment was at 10 am. I didn't get home until after 5 pm. 
      I'm down 31 pounds since the day of surgery and 47 since my pre-op diet began, with that typical week long stall occurring at three weeks. I'm really starting to see some changes lately- some of my clothing is too big, some fits again. The most drastic changes I notice however are in my face. I've also noticed my endurance and flexibility increasing. I was really starting to be held up physically, and I'm so grateful that I'm seeing that turn around in such short order. 
      My general disposition lately is hopeful and motivated. The only thing that bugs me on a daily basis still is the way those supplements make my house smell. So stink! But I just bought a smell proof bag online that other people use to put their pot in. My house doesn't stink anymore. 
       
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    • BeanitoDiego

      BeanitoDiego

      Oh yeah, something I wanted to rant about, a billing dispute that cropped up 3 months ago.
      Surgery was in August of 2023. A bill shows up for over $7,000 in January. WTF? I asks myself. I know that I jumped through all of the insurance hoops and verified this and triple checked that, as did the surgeon's office. All was set, and I paid all of the known costs before surgery.
      A looong story short, is that an assistant surgeon that was in the process of accepting money from my insurance company touched me while I was under anesthesia. That is what the bill was for. But hey, guess what? Some federal legislation was enacted last year to help patients out when they cannot consent to being touched by someone out of their insurance network. These types of bills fall under something called, "surprise billing," and you don't have to put up with it.
      https://www.cms.gov/nosurprises
      I had to make a lot of phone calls to both the surgeon's office and the insurance company and explain my rights and what the maximum out of pocket costs were that I could be liable for. Also had to remind them that it isn't my place to be taking care of all of this and that I was going to escalate things if they could not play nice with one another.
      Quick ending is that I don't have to pay that $7,000+. Advocate, advocate, advocate for yourself no matter how long it takes and learn more about this law if you are ever hit with a surprise bill.
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    • BeanitoDiego

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    • ChunkCat

      ChunkCat

      Thank you everyone for your well wishes! I totally forgot I wrote an update here... I'm one week post op today. I gained 15 lbs in water weight overnight because they had to give me tons of fluids to bring my BP up after surgery! I stayed one night in the hospital. Everything has been fine except I seem to have picked up a bug while I was there and I've been running a low grade fever, coughing, and a sore throat. So I've been hydrating well and sleeping a ton. So far the Covid tests are negative.
      I haven't been able to advance my diet past purees. Everything I eat other than tofu makes me choke and feels like trying to swallow rocks. They warned me it would get worse before it gets better, so lets hope this is all normal. I have my follow up on Monday so we'll see. Living on shakes and soup again is not fun. I had enough of them the first time!! LOL 
      · 0 replies
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