Q for self pay due to wls exclusion

Hello,

Question to Self pays due to WLS exclusion in your policy...

So if you have wls and pay your self...will the insurance then not want to pay down the road if there is a complications or for tests Drs may need to do for you later ? or for appointments with dr ..such as strictures? or any other possible complication that could arise ??

Just wondering how crappy a insurance company can really be..if they do exclude you pay then 6 mos or a year or so down the road and a issue arises due to your self paid wls ??

Thanks! you can PM if you prefer not to post

Loren

hi
i was self pay and mine paid for MOST of the pre op tests (just not the nutruitionists), I also had 3 strictures and it paid for those and the followups.  At the time, i had the same crappy insurance that woudlnt pay for the surgery and it paid for the psych eval, all the pre op stuff, etc etc blah blah etc lol.  And yes i worked for a hospital that did the surgeries and woudlnt pay for them for their own employees.  However, i was in the hospital 5 days for a lap RNY due to anesthesia issues and there was no extra charge from the self pay.  I ended up having 3 strictures that were taking care of by a gastro doc (my surgeon referred me too) insurance totally paid for that no problem. So, you should be good to go. Of course this all depends on your particular insurance but that was my experience 3 1/2 years ago. 
I didnt notice which surgery you are looking at but just FYI my RNY was $20,500

Liz

Hello and thanks for the replies !

So I hope that would be the case with my insurance also, funny thing is my carrier is UHC and they are actually wls friendly,,,,its my employer Qwest that does not pay for any wls .....but they are paying for my takedown of my old vbg and hernia repair I have to pay for the RNY....so who knows what they would do if there were future issues,,btw,.i had my vbg 9 years ago and it was not thru them....

So far they have paid for my EGD..and 3 consultation appts....

Scary wondering what would......happen if there was a issue the hospital if things didnt go as planned or a future issue,,,looks like yours still came thru for you quite well...even though they didnt pay for wls,

Thanks!
loren

I really don't know but if you'll post this on the insurance board I bet there's someone there who can tell you.  www.obesityhelp.com/forums/insurance/

Thanks for the suggestion, always forget about those other forums.....well guess im giong to bed...,maybe by when i get off work I  will have more replies etc....

I was self pay but didn't have any complications to know if I'm would of paid.  I have a new insurance now and it does scare me if something should happen.  I believe though that if I would have a complication like a bowel obstruction it would pay.  It's been almost 5 years since my RNY, obstructions can happen at any time not just due to WLS.

How did I get my labs paid?  My doctor (PCP) ran them and coded it not as WLS lab work.  Even with this insurance I currently have the codes they use are for annual physical, which my insurance will pay 100% for certain test, the others I do have to pay for after I meet my deductible.

you are so beautiful..

how you and my three boys doing..??

OMG Russ, where you been?  I haven't talked to you in such a long time.

The three boys and I are doing well....busy as can be but it's good. 

Check your policy.  Mine states that they pay for nothing connected to WLS before or after even if it is medically necessary.  That includes everything,  However, I have had labs done ordered by my pcp and they have paid.  I guess as long as your doctor files under a normal medical code they don't make the connecftion.  Also if they did not pay they may not realize the surgery was done unless they discover it on their own.

Hi. I am a Barker patient too with UHC that has an exclusion clause AND I am having my band of 3 yrs removed and converting to a sleeve. I am using a phone and can't message u for some reason. So here is my number if u want to text me. I will b more than happy to share what I have learned through all this.

Btw I lost 96 pounds with it but found 30 since the complications (fluid removed).

469 471 8659