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Ready for the band, but ONE question????


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If you get this surgery, and end up with a problem such as slippage, erosion, etc. Does Ortiz cover the cost of removal, or is that another surgery you have to pay for? I know my insurance won't cover it. They won't have ANYTHING to do with any kind of weightloss procedure.

Anybody know anything about this? Thanks!

Donna

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If you get this surgery, and end up with a problem such as slippage, erosion, etc. Does Ortiz cover the cost of removal, or is that another surgery you have to pay for? I know my insurance won't cover it. They won't have ANYTHING to do with any kind of weightloss procedure.

Anybody know anything about this? Thanks!

Donna

My understanding is that re-banding or removal is sort of negotiable. During one fill visit, I met a nice woman that had lost all of her excess weight, then had a slippage. I asked if she had to pay full price again, and she said 'we worked out a deal'. I think it kind of depends on the circumstances.

Luckily, after reading my policy, I am almost certain my insurance would cover an emergency removal, but I doubt they would pay for a re-banding.

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My understanding is that re-banding or removal is sort of negotiable. During one fill visit, I met a nice woman that had lost all of her excess weight, then had a slippage. I asked if she had to pay full price again, and she said 'we worked out a deal'. I think it kind of depends on the circumstances.

Luckily, after reading my policy, I am almost certain my insurance would cover an emergency removal, but I doubt they would pay for a re-banding.

Greg, did your insurance cover your surgery, or were you selfpay? I'm assumming you were self pay since you went to MX. I'm just wondering if my Ins would cover it if it was an emergency type situation. Who knows? Insurance companies are the DEVIL. :angry: LOL

Donna

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Greg, did your insurance cover your surgery, or were you selfpay? I'm assumming you were self pay since you went to MX. I'm just wondering if my Ins would cover it if it was an emergency type situation. Who knows? Insurance companies are the DEVIL. :angry: LOL

Donna

I was self pay. The section to look for is in the exclusions of your insurance policy. If it says 'Treatment for obesity, including any gastric surgery for morbid obesity are not covered', most likely an emergency after banding would be covered. However, if your policy states 'Bariatric surgery AND any complications from such surgery are not covered', there could be a problem.

And are insurance companies the devil? Well, they sometimes seem to be, but most companies are simply enforcing the terms of the policy. I have UHC (United Healthcare PPO), which excludes bariatric surgery in my policy, but I know of many people with UHC whose policies do cover the procedure. Often times, it is the employer that chooses whether certain procedures are covered. In my case, my employer has a Cadillac policy, that just happens to exclude WLS. However, they cover vision, chiropractic and have $10 copays for any doctor visit, and $8/$16 prescriptions, with no deductibles and 100% coverage with no co-insurance. My employer also pays the entire premium for this policy.

But yes, some insurance companies seem to take direction from a CEO named Lucifer. Its all about money.

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True Greg. Can't completely blame it on the ins company. In my case it is my employers fault. Wellmark BCBS does pay for lap bands, but Procter & Gamble PAYS to have a rider stating that is does NOT pay for it. Thanks for the info, I'll check out the exclusions again.

Donna

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I should also point out, that many companies are self-insured. P&G is a large enough company to make me think that may be the case. They hire an insurance company to administer their health plan, but actually every dollar of benefits are paid by the employer, not the insurance company.

Similar to hiring a general contractor to have a house built. They hire all the work done, but you pay the actual expenses, plus an admin fee.

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