Question:
I need to know if insurance will pay for complications due to surgery?

I have bc/bs and the rep told me today that if I have any complications due to the wls I will have to pay out of my pocket. I said if I had a different kind of surgery and had problems they would pay for it? She said yes. I've never heard any one mention this before and I've read alot where people had to go back in for complications. I'm not sure I should have this surgery if this is the case. Thank-you for your input. Geralyn    — Geralyn (posted on February 1, 2002)

February 1, 2002
That doesn't sound right to me! I know that any complications I have (knock on wood) will be covered by my insurane (Capital District Physicians Health Plan). I'd ask to see that decision in writing. Any lawyers out there know if this is even LEGAL????
   — Kathy J.

February 1, 2002
I just had another thought. IS BC/BS paying for your original WLS? If not, then it would make sense that they might not cover complications resulting from a surgery that they are not approving. However, if they are approving and paying for your WLS, it still doesn't make sense to me that they wouldn't cover complications resulting from an approved surgery.
   — Kathy J.

February 1, 2002
I had a few complications after surgery and BC/BS paid for everything. I only had my co-pays to pay. If you are interested in hearing what happened, just look at my profile. Best of luck to you.
   — Laura M.

February 1, 2002
It probably depends on your policy. I also have BCBS, ND PERS (through my work) and I had a complication that required another surgery 2 weeks later. My insurance paid for all of the second surgery. Every penny of it. I'd check your policy, and if possible, ask to speak to a supervisor at your insurance company. A lot of times the first person you talk to at insurance companies don't know the answer to every question, and they give completely wrong answers. Good luck!
   — Becky H.

February 1, 2002
i have bc/bs and had alot of complications after surgery and the insurance company has paid its share so far.(and i'm talking major $$$. into the hundreds of thousands now.)
   — [Anonymous]

May 2, 2002
I have been very forutnate with my insurance company because I have had 3 emergency surgeries and 1 scheduled surgery that turned into a 7 hour ordeal... the insurance company has paid all that they are supposed to. Find out what kind of complications that they exclude and why they exclude them. If I had to pay out of pocket I would of had to pay my hospital $175,000. I couldn't afford that at all. Good Luck!
   — Tabitha W.

December 18, 2002
Sometimes the answer depends on who you speak to. I called within an hour apart to the claims office regarding my denial for surgery. The first rep told me there was a new policy in effect which prohibited these surgeries as they were 'cosmetic'. Well I was fuming! I called an hour later (no joke) and asked to speak to a supervisor regarding my claim rejection (I was ready for a fight this time) and she said I simply needed to re-submit everything to the appeals department ASAP. Approved 45 days later. So fight back!
   — teresa V.