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Self-Pay, Insurance and Complications Questions

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Old 10-12-2009, 04:29 PM   #1
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Question Self-Pay, Insurance and Complications Questions

Hi All,

I am hoping that y'all can help me out with this question. If I self-pay for my WLS (the sleeve) and there are complications resulting in a longer hospital stay then will my insurance (Medicare) pay for the hospital bill for the extra days? I do know that the surgeon's fee for complications is included in the self-pay but not the hospital bill.
I can ask the surgeon next week but I am wondering if anyone here knows about this?
Thank You!
Pennie
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Old 10-12-2009, 04:46 PM   #2
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I don't know about Medicare specifically, but I know that primary insurance plans will not pay for any bills that result from complications due to non-covered procedures.
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Old 10-12-2009, 04:47 PM   #3
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Great question. Best thing to do is call your insurance company.

Please let us know what they say ... good luck !!
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Old 10-12-2009, 06:46 PM   #4
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I'm not hopeful about this, Cat. but leenie's right - contact your carrier - who's your medicare provider?
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Old 10-12-2009, 08:38 PM   #5
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I called Medicare and got an inconclusive answer. Medicare would make a decision whether to cover me at the time of complications. Well, that is not too helpful information. I think there has to be a better answer. Perhaps I will call again but it is obviously not a question that they get a lot. I need a Medicare expert.
Thanks everyone for your responses.
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Old 10-13-2009, 10:05 AM   #6
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and that's probably the best answer you will get. What I'm not sure is why you are self pay... medicare covers WLS...
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Old 10-13-2009, 10:08 AM   #7
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I bet they would NOT cover it. I am facing the same thing with my boobs and stomach and my insurance company. They won't cover any portion and if there are to be complications it will continue to be outta pocket for me.
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Old 10-13-2009, 10:20 AM   #8
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Thighs - Same with me on my boobs, insurance will cover no part of any complication resulting from the procedure. Check with your surgeon - they often offer warranties you can buy up front that cover surgical costs for redos or replacement. Some guarantee their work and do any repair for free or greatly discounted.

Pennie -I'm the plan administrator for our insurance plan and spoke to our Medicare liason this morning on another matter, asked her your question. She said the same thing - decided on a case by case basis. She added that they are more likely to decline if it can be totally linked to the optional surgery. In the case of extra hospitalization after the procedure, that would be pretty clearly as a result of the procedure. Even she couldn't say for sure, though. Good luck.
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