x-post....Insurance question regarding care after RNY

iisme
on 1/7/10 4:03 am
We had an insurance change a of 1/1/10. When I had my RNY we had excellent insurance with BC/BS of MA. My husband went back to work for his old company and starting this year we now have BC/BS of GA with a WLS exclusion.
I just called them on Tuesday asking them if they would pay for my yearly labs etc. I got a call back today. What was relayed to me is that they would pay NOTHING for anything with a diagnosis code of obesity, the treatment of or WLS complications if it was coded as such.
Can they really do that if I already had the surgery under another plan which paid for my surgery? Under my new plan the family is not subject to pre-existing conditions because we have continually had health insurance coverage.
Will most doctors and hospitals be willing to code it as something else if I do end up having complications?  This just seems not right at all.


10 pounds loss pre-op
Cindy F.
on 1/7/10 10:13 am - Freeland, MI
Nora - seems odd that the BCBS plans would be so different.  Might be something specific your husband's employer has written in their policy?  Regardless, I would think if your regular doc orders labs II'm assuming you're talking bloodwork, etc.) and they just state that they're part of your annual checkup or something it should be covered.  it's not like those would be something specific to WLS patients.  Sorry to hear about it - insurance companies can be a pain.  Usually BCBS plans are better than most.  At least you've already had your surgery!
Cindy
Cindy F.
on 1/7/10 10:16 am - Freeland, MI
Well I'm obviously ignorant to the fact that "x-post" must mean remove the post or something because now I saw your other post.  Thought it was kind of odd nobody had responded to this!  Sorry - I'm a ding-doing newbie. 
Hope all works out for you - looks like you received a lot of good responses. 
iisme
on 1/7/10 12:09 pm
Thanks so much for your reply.
Yea BC/BS can vary greatly depending on the plan the employer decides to purchase. This one has a WLS exclusion and yes, I am SOOOOOO very thankful that I have already had my RNY.
It just worries me that some doctor or hospital will screw up and put down that I have some sort of complication and then document it as "complication of RNY"
X-post simply means.....cross post meaning I posted it on here and the RNY board.


10 pounds loss pre-op
Cindy F.
on 1/8/10 10:07 am - Freeland, MI
I'd be worried as well - everyone's looking for a reason not to pay something.  Hopefully you won't have any problems. 

And, thanks for the explanation of "x post" - I still didn't get it right!!! LOL  I have so much to learn from you Nora.....    Thanks for being patient with me.  
GigiNorth
on 1/20/10 9:45 pm
The yearly labs should not have a diagnosis of obesity  - unless the surgery failed :)

Assuming you are not a adjustable band patient

579.3 Other and unspecified post surgical nonabsorption (Malnutrition following gastrointestinal surgery).

There are also specific codes for specific vitamin and mineral deficiiencies (For example 268.9 is unspecififed vitamin D deficiency).

The point to remember is the labs are not done due to obestity, but due to malabsorption of nutrients.
Gigi North
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