One Weight loss surgery per lifetime

 One Weight loss surgery per lifetime

Many insurance companies are adding that, and I see so many people misunderstanding that.

It doesn't mean "one WLS per lifetime UNLESS  you paid for the first one".

It doesn't mean "one WLS per lifetime UNLESS some other insurance company paid for the first one".

So to me this means, regardless of who pays, "do research and pick what's right the first time, or I'm screwed".

Research,research research!

 

I had that issue and was able to appeal that decision based on total failure of the lapband surgery. Now with that said if the RNY doesnt work, Im pretty much screwed.

But of course it will work, you did the research, right?

*SNORT*

See, I find this interesting.  I have had lap band for 9 years. I worked at a different company and had different insurance. I did well initially and then it slipped one year later. i did have it repaired and since then, I have had a lot of upper left quad pain and have to done well.  9 year later i realized that I need to do something about my weight. I called my insurance company and told them i wanted to have the RNY. I also told them that I had the lap band 9 years ago.  She asked if I had worked for my current company or had this insurance and I told her no..  She told me that 'it wouldn't be a problem" .  Fast forward 8 months.... yup they are denying me do to me having a lap band.

 Tammi, see my comments below. As for a copy of your rider.

 It means 1 WLS per lifetime per insurance company. Every insurance policy is different.  I had my RNY with HealthNet, I had my Lap Band with Aetna.  The issue will be in the future when insurance companies start buying up other insurance companies and left are left out there.  Please don't mis-educate someone when their is so much mis-education out there. The first thing my insurance company asked me when I submitted my revision pwk was who did your first? And they did in fact say that they would not allow it had they done it.  My bariatric rider lists 1 per lifetime at a baratric center of excellance and also lists the types of surgergies approved (which in my case is all). It also lists the criteria for a revision so what you are saying about is false.  I am also lucky bc I have a PS rider that is tied to my bariatric rider for up to $20K in PS after WLS.

See, that is why I am soooo frustrated.  I was told the same thing. That it is per insurance company.  I was told this initially last spring. Now, I am being told that it is if you have ever had any type of bariatric surgery. They told me it didn't matter which insurance I had.  I have two people telling me different answers.  My particular insurance states they will not allow another bariatric surgery (revision) unless their is a stricture or blockage. That was not was I was told up front.. After spending months of going throught the program, getting all my presurgical clearances and also putting over 5,000 in my HRA account to help cover my deductibles, they are now denying me.

 Tammi, please ask your employer or your insurance company for your plan benefits and details.  

Here is how mine reads " Bariatric 100% after $750 per confinement copay; deductible waived Limited to $20,000 per lifetime, includes National Medical Excellence. Travel and lodging expenses covered separately.Only considered an eligible expense if incurred at an Aetna designated Institute of Quality.Precertification required. The member cost sharing applies to all covered benefits incurred during a member's inpatient stay. Expenses for surgeries to remove excess skin resulting from weight loss will be covered up to $15,000 per lifetime."