sbjim5755

Hi everyone,

I was wondering if any of you know if insurance will pay for an ER visit after my tummy tuck. I had a belt lipectomy done on April 2nd and had to go to the ER yesterday because I had a 103 fever. After test, chest x-ray, cultures, etc it was determined that I was dehydrated and had a mild case of pneumonia. They gave me two heavy duty antibiotics with the IV fluids for my dehydration. Do you think it will be covered. I have Pacific Care HMO in California.

I don't want to call and ask just in case the paperwork would have gone through ...because I know on the ER discharge paperwork my diagnosis was an acute febrile episode, dehydration and Pneumonia. What do you think?? Thanks for your input

__________________
Jim
Post Op Lap Gastric Bypass on 10/27/05
Weight - 371/336/169/170
pre-op/surgery/current/goal
202 Pounds Gone Forever!!!!!!
Plastics Surgery (Belt Lipectomy) - on April 2nd

MiladyB

Jim, I can't swear to it but I would think they would. It should have been sent to your insurance company with the codes for dehydration and Pneumonia...I would think those would be something that your insurance covers.

Hope you are feeling better. If you have an incentive spirometer at home use it often. That's one of those sucky things that gets you to take deep breaths. I know they may seem silly to use but believe me, they are one of the best things you can do for yourself.

__________________
~Beth~

Little Victories; Grand Rapids, MI
Bariatric Support Group

Diabetes, high blood pressure, sleep apnea, high cholesterol,
peripheral vein disease, joint pain and 210 lbs GONE!!


Century Club: July 3, 2006
ONE-derland: Dec. 22, 2006
Double Century: May 29, 2007
Goal: June 15, 2008

Lap RNY: 1/30/06-Dr Randal Baker
TT/BL: 09/21/07-Dr Ronald Ford
PS Revisions: 04/29/08-Dr Ronald Ford
Gallbladder: 05/14/08-Dr Randal Baker
Emergency surgery (Intussusception): 02/29/09-Dr James Foote

sbjim5755

Thanks Beth,

Ido haveone and use it every timethere isa commercial on TV...Thanks for the advice.

__________________
Jim
Post Op Lap Gastric Bypass on 10/27/05
Weight - 371/336/169/170
pre-op/surgery/current/goal
202 Pounds Gone Forever!!!!!!
Plastics Surgery (Belt Lipectomy) - on April 2nd

SueRN

I work for an insurance company. Did your insurance actually deny the belt lipectomy or did you just do it all on your own? The reason is when the claim comes in and it's reviewed, it may deny due to a complication of a non-covered or denied service. Some codes for certain diagnosis will trigger a medical necessity review and some don't. It's possible that you may have to cover the ER bill. Hopefully, the ER bill will just sail thru claims and that will be it. But I would prepare myself to get an ER bill just in case. I'm keeping my fingers crossed for you. Hope you are doing better. Sue

Debz

Running through some old posts....and was wondering how this turned out. You still posting? If you are, did they pay? Thanks...

__________________
Debbie
Lap RNY 8/6/07
Highest/Day of surgery/current/goal
251/237/126/131


Goal! I did it!
111 pounds gone since my RNY
125 total pounds gone forever!
Maintaining within a few pounds up and down. 130 is my goal and I've been hovering a pound or two over it for months now.
BMI 22.3


I am not a tame lion......

nittinnana

Hi--I did medical billing for years--if the dx is different it should be paid for no problem. If it is denied I would fight it-

__________________
Mary

wt b4 pre-op diet 249.4
day of surgery 236.8
current 136.6
first goal met St. Patrick's Day! 160
new goal (normal wt) 144

Century Club on April 30, 2009!

NO LONGER OBESE--ONLY OVERWEIGHT AS OF 1/6/08
ONDERLAND 11/11/2008!

GOAL MAY 19, 2009!