Calling Experienced Insurance claims/coding persons.......

Could you please share your opinions regarding COMPLICATIONS and billing post-op?  Here's the scenario--I am self-paying for a VSG despite the fact that 8 months ago I could have had my insurance cover RNY or Lap.  I understand that I will be responsible for any costs associated with complications that are coded as such resulting from my surgery.  BUT, I'm wondering how can the insurance company prove that something is a direct complication of the surgery and for how long after the surgery can it be considered a complication?

Here are my specific scenarios:  If I were to become dehydrated immediately following the surgery (not uncommon) and receive fluids in the ED, I can see that claim being denied due to complication of non-covered procedure.  How about an esophageal stricture 6 months out?  Those happen to the unsleeved, how would they prove that it is a surgical complication?  Another one would be a duodenal ulcer 3 years post-op?  (I've seen several postings about that lately..........)

What do you think--covered or not, and would it come down to the wording the MD used in chart notes?

Sorry so long............thanks for reading and providing feedback!

This is a great question and while I don't have the answer I would be interested in the answer. You might consider cross posting to the Main board as not a lot of people come to this board and many more will see it there. Thanks ffor posting!
Holly

Thanks for the idea Holly!  I took your advice and posted the question there.........let's hope it gets a few responses! 

Yes,I hope it dies. I will be looking for it there!
H

I am not a coder or claims person but you can read about my complications  on my page  from a year ago. Doc said it didn't have to do with band surgery, I think that is BS but my ins did pay for everything minus deductible and a few odd bills here or there. I was cash pay for band, it is excluded from my policy but, they did cover what happened after. Still am not sure what happened so $10,0000 down the drain