Severe anemia, insurance not covering infusions, what to do?

I'm just at my wits end. I'm almost 9 years post-op (Roux-en-Y, many complications) and now find myself so severely anemic that I was told by a hematologist that pills will never get me up to where I need to be and I desperately need iron (dextran) infusions immediately. He's ordered 3 weekly 8 hour infusion sessions and then will check my blood, then plans on infusing me probably once a year, every year for the rest of my life. Sounded good to me until my insurance denied the treatment because it is related to my gastric bypass which was not originally covered, even though they have covered approximately $200,000 of complications since then. So I've had 3 emergency blood transfusions to sustain me the past three days and I will talk to the clinic tomorrow about the cost of the dextran infusions. Does anyone have any idea how much they cost without insurance? My anemia really is so bad (hemoglobin 7, ferritin 2) that I cannot function and my heart is constantly stressed. What do I do if I cannot afford it? Thanks for listening! I'm really a wreck!

I have no idea how much it would cost, but I would strongly encourage you to appeal this decision with your insurance company.

I ran into something similar when I had a silicone breast implant leaking.  My insurance refused to cover the tests my doctor ordered because breast implants were considered cosmetic surgery. 

My appeal argument with my insurance company was two fold.  The first was that while the breast implant was cosmetic, the damage it was doing to my body made it a medical issue and should, therefore, be a covered service.  I also pointed out that if I'd had a tattoo or piercing that had become infected or sepsis, the medical care to treat that would be a covered service, yet tattoos are also cosmetic...

To be honest with you, I did not stick around to fight the appeal through.  I instead made the decision that time was of the essence as silicone was leaching into my body, so made the decision to self-pay for the care I needed.  However, I still believe that had I been willing to take on the fight through the appeal process that I stood a good chance of winning.

Another thing you have in your favor is that they have paid for other care related to your surgery; therefore, they have established a precedence that they do indeeed pay for services related to wls, which you can also use to your favor.

Good luck!!!

I am also anemic and it is a complication of my surgery 6 years ago.  I've had 16 infusions since May and still my numbers do not hold. 


My old insurance company which did not pay for the surgery did pay for my infusions.  However, there were certains ones they wouldn't pay for.  I wonder if the dr could reword why you need it and if a different infusion would be covered.  Good luck to you.  You will feel so much better when you get them.  Good luck

And they can PROVE this is related to your surgery...how?


Is it something your doctor wrote?  Can he rewrite it?  There is no way to PROVE that the anemia is realted to your surgery.

Quick update: still haven't heard from the financial dept. about the cost of the infusions so if anyone knows a rough estimate please pass it on. And as for fighting the insurance, the hematologist said he had a patient in the same cir****tances with the same insurance (it's a common one) a few years back that fought for months and still never got it paid for. He said I could hire a lawyer, but that would probably cost as much as the treatments. I think that since we've already alerted them to the fact that it is gastric bypass related, if we re-submit it under a different diagnosis they will see right through that and even consider it fraud. Meanwhile, I've had the blood transfusions and they've helped a little but it's only a temporary solution. I need these infusions!

  On February 17, 2012 at 3:21 AM Pacific Time, amyanne4 wrote: Quick update: still haven't heard from the financial dept. about the cost of the infusions so if anyone knows a rough estimate please pass it on. And as for fighting the insurance, the hematologist said he had a patient in the same cir****tances with the same insurance (it's a common one) a few years back that fought for months and still never got it paid for. He said I could hire a lawyer, but that would probably cost as much as the treatments. I think that since we've already alerted them to the fact that it is gastric bypass related, if we re-submit it under a different diagnosis they will see right through that and even consider it fraud. Meanwhile, I've had the blood transfusions and they've helped a little but it's only a temporary solution. I need these infusions!

I think that the assumption that it's bypass-related is fraud...

I have had lifelong iron problems that were not noticed until I had the DS.  (My iron was actually LOWER with the band, btw, because I could eat less.)

But the REAL culprit is a generitc condition called Thalessmia.  MANY, MANY people have it and don't notice it because they spend their lives at the border of okay & anemic.  Just eating less can cause cause them to become symptomatic...but the REAL cause is the Thalessemia...because people with Thalessemia--that includes MANY people of Mediterranean heritage, which I have--as well as other backgrounds, depending on the type of Thalessemia...start at a deficit.

And that starting at a deficit is the true cause.

The doctor did ask about thalessemia but a quick look at my labs prior to my gastric bypass showed that I was never anemic prior to the surgery and he looked to my Mom who was sitting in the appointment and she confirmed that there is no family history of thalessemia or anemia. So he is very confident that it can't be thalessemia. The gastric bypass makes sense because it bypasses the area where iron is absorbed. Plus, my diet has changed so drastically that I really don't eat enough foods that have it, and then those foods again bypass the stomach and area of the small intestine needed to absorb the iron. Looking at my labs, you can trace the anemia right back to the surgery and not before. I'm sure though that some people are misdiagnosed but it doesn't seem to be the case here.

Even if you didn't have it prior, most times there is no way to PROVE cause of anemia.
My daughter is anemic, no known cause and she gets infusions.
You need a new hemotologist or get the current one to rewrite that there is no way to prove cause. The insurance company knows this.

Quick update: After having to get the 3 blood transfusions to tide me over, I'm finally getting my first infusion on Friday. We gave up on my insurance company, mainly because the drug company agreed to provide the drug absolutely free (because of my financial situation) and the hospital/center providing the infusions will be offering a great deal of financial assistance as well. It's taken a long time to get everything in place but I'm so grateful they've been so willing to work with me. Now I just have to face getting the infusions, which scare me a little since I have read the horror stories of allergic reactions and I do have a history of many drug allergies. Wish me luck.