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surgery/insurance coverage??

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Ulcerative Colitis
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Posted 8/16/2008 8:18 AM (GMT 0)
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??? 
Posted 8/16/2008 1:05 PM (GMT 0)
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.
Posted 8/16/2008 2:40 PM (GMT 0)

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

Posted 8/16/2008 4:18 PM (GMT 0)
What's the main diff between jpouch sx. and BCIR?

Thanks
Posted 8/16/2008 4:24 PM (GMT 0)

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

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