"One in a Lifetime" Insurance Restriction for WLS
Okay, this might be a topic better served on the Main Board, but I wanted to talk about it here with my homies first, because it's something that has been really bothering me. Do folks really and truly understand that when they have a WLS procedure and insurance has agreed to cover it, that if there is a need for a revision down the road, insurance may or may not cover a second WLS procedure. I do not know the specifics of what various companies will or won't cover, and I'm wondering if this is something the companies have come up with fairly recently to protect themselves financially as more and more people are seeking WLS.
Please, if some of you could chime in here. For instance, what are the cases where insurance would cover having a band removed, since we all know this procedure is "reversible," which makes it so convenient. Will insurance cover a two-stage DS, for example, or will the sleeve portion only be covered?
Please, if some of you could chime in here. For instance, what are the cases where insurance would cover having a band removed, since we all know this procedure is "reversible," which makes it so convenient. Will insurance cover a two-stage DS, for example, or will the sleeve portion only be covered?
The once in a lifetime clause started showing up a few years ago.
And as a revision, yes it was a WHOLE set of new criteria I had to meet !!
To include also meeting thr ORIGINAL criteria...
The only thing that kind of saved me was I had complications CAUSED by the band and it needed to be removed alon with a mass and stomach repaired ...
One of my friends had to self pay for her 2nd half of her DS, same insurance company.. She was a virgin DS with no co-morbids.( The DR deceided to do it in two stages, she wanted one stage.)
But it does depend on what the criteria is for each company, and also What different criteria they each need for revisions.
And as a revision, yes it was a WHOLE set of new criteria I had to meet !!
To include also meeting thr ORIGINAL criteria...
The only thing that kind of saved me was I had complications CAUSED by the band and it needed to be removed alon with a mass and stomach repaired ...
One of my friends had to self pay for her 2nd half of her DS, same insurance company.. She was a virgin DS with no co-morbids.( The DR deceided to do it in two stages, she wanted one stage.)
But it does depend on what the criteria is for each company, and also What different criteria they each need for revisions.
for kjfras (Kerry) 
I was a virgin DS, and I'm disabled, so Medicare and Medicaid will pay for any necessary revisions if they are deemed to be complications from the original surgery. My obesity was contributing to the severity of my disabilities (lupus and fibromyalgia) so it turned out to be medically necessary, thanks to great documentation from the GP and other doctors I see.
Dr. Inman is my surgeon, and her staff is *expert* at dealing with insurance companies and getting surgeries approved. The process starts *immediately* after the seminar.
My advice is to work very closely with the insurance person at your surgeon's office. They usually know how to get through the red tape and get you approved, even for revisions, which are tougher, *documentation* is the key! As long as you've got issues with your current surgery documented.
As for staging, I was going to go for that, but that would mean two abdominal surgeries. I thought twice. I got cut once. In a case like that, where staging is absolutely necessary, the insurance expert at your surgeons office may be able to get an override.
Dr. Inman is my surgeon, and her staff is *expert* at dealing with insurance companies and getting surgeries approved. The process starts *immediately* after the seminar.
My advice is to work very closely with the insurance person at your surgeon's office. They usually know how to get through the red tape and get you approved, even for revisions, which are tougher, *documentation* is the key! As long as you've got issues with your current surgery documented.
As for staging, I was going to go for that, but that would mean two abdominal surgeries. I thought twice. I got cut once. In a case like that, where staging is absolutely necessary, the insurance expert at your surgeons office may be able to get an override.
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