surgery/insurance coverage??

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~ChristieAnn67~
Regular Member


Date Joined Dec 2007
Total Posts : 151
   Posted 8/16/2008 3:18 AM (GMT -6)   
just curous...what are you all finding out about insurance coverage regarding surgery??  Are they only wanting to cover in emergency situations?  What are they thinking about getting it done when we are in remission to avoid possible complications?   Are they open to covering it no matter what??  I"m curious,  because I'm seriously considering just having it done,  and get off all these potentially dangerous drugs once and for all...  what do you all think??? 
                                          ~Christie
41 yo RN, happily married, with 2 beautiful daughters, Tianna(14 yo) and Alyssa(10 yo).   Diagnosed L sided Ulcerative Colitis in Jan '04 and Diabetes type 2 in June '05. (Complete remission from Nov. 07 to July 08 d/t Remicade) But,  a flare July 08,  currently controlled with prednisone and last remicade on July 31st...Hope it stays that way!!!
                                         Medications
Remicade infusions ~ 11/6/07, 12/6/07, 12/20/07, 2/14/08, 4/10/08, 6/08, 7/31/08.  6-MP 100mg daily, Pentasa 500mg twice a day, Lantus insulin 15 units daily, Amaryl 2mg daily, multi-vitamin daily, Calcium daily, B complex vit daily,  and pro-biotics daily. (currently on pred taper...down to 5mg twice a day)


jujub
Elite Member


Date Joined Mar 2003
Total Posts : 10407
   Posted 8/16/2008 8:05 AM (GMT -6)   
It depends on your coverage, but most policies cover any medically necessary surgery that isn't "experimental." Colectomy and J-pouch are not experimental, and the fact that someone has UC pretty much qualifies it as medically necessary. It's a treatment option just as medication is a treatment option.

I have heard that many policies don't cover BCIR (Brooke Continent Intestinal Reservoir). This is a procedure developed and patented by a surgeon, and he is the only one who can do it. I know some of the members here have looked into it, they may have more information.
Judy - Southern US 
 
Moderate to severe left-sided UC (21 cm) diagnosed 2001.
Avascular necrosis in both shoulders is my "forever" gift from Entocort.
Colazal,  Remicade, Nature's Way Primadophilus Reuteri. In remission since April, 2006.
 
Co-Moderator UC Forum
Please remember to consult your health care provider when making health-related decisions.


suebear
Veteran Member


Date Joined Feb 2006
Total Posts : 5698
   Posted 8/16/2008 9:40 AM (GMT -6)   

Surgery for UC is covered by insurance even if it is elective.  You do not need to wait for it to become an emergency.

Your surgeon will have an insurance specialist in his/her office that will work with your insurance company to ensure you are covered.  You don't need to do this work yourself.  If you opt for a BCIR the hospital that does that surgery will work with your insurance company to make sure you are covered. 

Sue


dx proctitis in 1987
dx UC in 1991, was stable until 1998

1998 started prednisone, asacol, pentasa, nortriptylene, ativan, 6MP, rowasa enemas and suppositories, hydrocortisone enemas, tried the SCD diet, being a vegetarian, omega 3s, flax, pranic healing, yoga, acupuncture, probiotics

2000 lost all my B-12 stores and became anemic

2001 opted for j-pouch surgery- now living life med-free


bbc
Veteran Member


Date Joined Mar 2008
Total Posts : 1580
   Posted 8/16/2008 11:18 AM (GMT -6)   
What's the main diff between jpouch sx. and BCIR?

Thanks
Mild to Moderate Pancolitis
Dx'd 05/2007
3 Lialda per day
Generic Rowasa daily or every other night
Probiotics, Bowel Soother, Fish Oil, Calcium, Multi Vitamin and Melatonin
Trying to reduce sugar in my diet but cannot tolerate artificial sweetners
I excersice daily
Did I happen to mention I HATE this disease!!!


suebear
Veteran Member


Date Joined Feb 2006
Total Posts : 5698
   Posted 8/16/2008 11:24 AM (GMT -6)   

J pouch surgery leaves functionality similar to having a colon and rectum.  BCIR and k-pouch are designed for intubutating in the stomach to remove waste (through a tube). 

Sue


dx proctitis in 1987
dx UC in 1991, was stable until 1998

1998 started prednisone, asacol, pentasa, nortriptylene, ativan, 6MP, rowasa enemas and suppositories, hydrocortisone enemas, tried the SCD diet, being a vegetarian, omega 3s, flax, pranic healing, yoga, acupuncture, probiotics

2000 lost all my B-12 stores and became anemic

2001 opted for j-pouch surgery- now living life med-free

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