Lap Band removal

goodlife1956
on 10/9/15 11:43 am

I had Lap Band surgery in 2006 and it eroded through my stomach causing pain, bleeding, and massive infection. I almost died. My insurance company, Humana, will not cover the surgery. Can they just let me die? Would this not be considered a pre existing condition? They say the fine print reads they cover no bariatric or problems arising from it. I am appealing, but I may need a lawyer.

hollykim
on 10/9/15 2:02 pm - Nashville, TN
Revision on 03/18/15
On October 9, 2015 at 6:43 PM Pacific Time, goodlife1956 wrote:

I had Lap Band surgery in 2006 and it eroded through my stomach causing pain, bleeding, and massive infection. I almost died. My insurance company, Humana, will not cover the surgery. Can they just let me die? Would this not be considered a pre existing condition? They say the fine print reads they cover no bariatric or problems arising from it. I am appealing, but I may need a lawyer.

there is an exclusion on your policy so, no they don't have to cover it. You can self pay for removal and that is what will keep you from dying, but yes , to answer your question, they will say it is not their issue.

It doesn't matter if it is préexisting thing or not as they have an iron clad exclusion. An exclusion means your employer didn't buy the coverage for any bariatric surgery. That makes the pre existing clause void in this issue.iThat is precisely why they have the exclusion worded

 


          

 

conazza
on 10/9/15 3:11 pm
RNY on 09/23/16

How awful!

Lap band: 2006. Revision to RNY 9/23/2016

8/2/17: Goal Reached: 135lbs. & 115lbs lost (5'3")

Pre-op: 250, SW 242, CW 125, GW 135

Pre-op: 9lb M1: 20lb M2: 11.5lb M3: 11.9 M4: 13.4 M5: 10.8 M6: 10.2 M7: 8.1 M8: 8.4 M9: 6.5 M10: 5.7 M11: 3.5 M12: 4.3

Nic M
on 10/9/15 4:24 pm

Is your health stable currently?

I assume the band has already been removed and now you're hoping Humana will pay? A lot of insurance companies are implementing super-strict policies when it comes to bariatric surgeries. I hope you can get it worked out. Recuperate well.

 

 Avoid kemmerling, Green Bay, WI

 

sheriberi29
on 10/12/15 5:42 pm - Cleveland, TN

Please let me know if you have found out anything by your insurance company. I was banded in 2009. I have pain in my port area and it is red and hot. Something is not right but I can not afford to pay for my dr to even see me bc he is 4 hours away and refuses to accept payments. I'm at a loss

(deactivated member)
on 10/13/15 8:44 am - NY

Sheri try to get seen at a local ER that dos weight loss surgery. Hospitals need to see EVERYONE regardless of ability to pay. You could apply for charity care (don't need to be on Medicaid to do this) or make a payment plan of $10. a month. Red and hot usually means infection. You don't want to make a simple situation worse. You may need an antibiotic. Your health is worth it. Use a credit card if you have to. Feel free to pm me if you need help. Just go.....today. Please.

sheriberi29
on 10/13/15 9:02 am - Cleveland, TN

Thank you. I just got off the phone with my lap and dr and he said unless I'm vomiting he will see me on Monday but I do need to be prepared to pay $225 , plus the 4 hour trip ... I'll go and he said my insurance does have to pay to have my band removed if it is eroded but they don't have to revise or replace it. It will also have to pay for the scope to look and see if it's eroded.

(deactivated member)
on 10/13/15 10:10 am - NY

So glad you are getting seen! If it gets worse before Monday remember go to the ER. Especially if you get a fever.

CSG_61615
on 10/27/15 3:14 pm

That is awful. Definitely get a lawyer who specializes in handling denial of health insurance claims. Candy

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