Question for Self Payers??????///

[Bell1138 1]

I was wondering if you are self pay and you pay to have the lap band surgery, and for some reason or other the band slips or their is a problem with the band, do you have to pay to have another surgery. I don't know how I would pay for any type of repair surgery, I am struggling to pay for the initial lap band surgery.

[Jessrw 0]

I was self pay and my doctor said that if something was to go wrong and if I needed another surgery then I would have to pay for it. It is kinda scary to think about but My thinking was that if i do everything right and follow all the directions I should be good. I needed this too bad to worry about the what ifs!

[NewYearNewMe2010 0]

yes- I was self pay & my doctor was sure to tell me that if something happened I would have to pay out of pocket to fix it.

[adagray 1]

Yes, if you are self-pay for the initial surgery, then you would have to self-pay if there are any complications and also for fills. Many surgeons include fills for the first year w/the fee you pay them for the surgery. Definitely check w/your specific surgeon, though, to make sure. I've heard that some surgeon's may begin to offer their own 'insurance' in a way... basically, you pay extra for the surgery (like $1k extra) and they will guarantee that if you have any complications where they need to do a port revision, etc., that they will then do it at no additional fee. This is not common, though, so definitely ask around.

The main reason I fought so long w/my insurance company for them to cover this is not so much because of the initial surgery fee. Yes, its expensive, but I know it would be worth it. But, the idea that I would be taking an unknown financial risk for my family (as far as complications and additional fees down the line) was scary to me. But, doing nothing is also scary when you have comorbid conditions. I would just encourage anyone who has insurance to fight your insurance company for coverage. I was denied twice and was granted coverage on the second appeal. So, no does not always mean no.

[onikenbai 33]

It depends on where you are. My package included unlimited fills and un-fills for life, and if there was a problem with the band the second surgery would be covered unless it was obvious that I did something like massive, chronic overeating to screw it up. Band erosions or port problems are totally covered for me.

If you get a band and it's clearly defective from the get go, or they miss with the needle and stab your tubing, there is no reason in the world why you should have to pay to fix that! Just my personal opinion.

[outside*looking*in 0]

It depends on where you are. My package included unlimited fills and un-fills for life, and if there was a problem with the band the second surgery would be covered unless it was obvious that I did something like massive, chronic overeating to screw it up. Band erosions or port problems are totally covered for me.

If you get a band and it's clearly defective from the get go, or they miss with the needle and stab your tubing, there is no reason in the world why you should have to pay to fix that! Just my personal opinion.

That is a great deal. Do you mind sharing your cost? My deal is about $18,000 total for surgery and that includes 1 year of fills and if any repair/surgery is needed in the first year it is covered.

[timetobefree 5]

I, too, was concerned about this, but I'd rather be skinny and poor from having to pay for another surgery than fat and rich but nearly dead. The chances something are going to go wrong are low, while the chances the weight was going to kill me were high.

As for fighting your insurance, if there is an exclusion to WLS written in, you are SOL. If they are denying you for other reasons, the fight might be worth it. But fighting an exclusion is an exercise in futility.

Amy

[arthukd 1]

If you get a band and it's clearly defective from the get go, or they miss with the needle and stab your tubing, there is no reason in the world why you should have to pay to fix that! Just my personal opinion.

While that seems like a reasonable statement, it is not true. If there are complications during surgery there may be additional costs, which would be your burden to pay.

Be sure to check with your doctor and consider any additional financial expenses as one of your risks when deciding to proceed or not proceed w/ lap-band.

[emjay 8]

Generally, if you're self pay because of a WLS exclusion in your plan, then any complications due to that surgery would also be excluded. Not always, but as a rule I would say more often than not with healthcare costs out of control. Self-funded plans, especially when moving to a new administrator, will be asked if they want to pay for complications related to an excluded procedure, and most say they do not want to pay for them.

[Melinco 1]

When I was checking with my insurance carrier, Aetna, who my employer uses (and self-funds), they said that while WLS is NOT covered, they would cover any complications, as long as it is not coded WLS. For instance, say I get sick, begin puking violently, and end up in the ER. As long as it isn't coded weight loss surgery (which it wouldn't be) it will be covered. Now I know that if for some reason I have to go in and have the band repaired, I'm footing that bill.

My best advice is to become very familiar with your insurance policy, asking what is and is not excluded. Don't be afraid to ask for a copy of the certificate of coverage or summary plan document, where all of the exclusions are listed.

[BethMassengale 0]

I was self pay. My doctor since I was self pay gave me a $2500 discount and the fees covered fills for 6 months. The hospital also gave a discount for cash payments. You may want to ask. They worse thing they could says is no.

[Shar Pei 0]

My insurance did not cover either...however, they did pay for part of the anesthesia and the surgicenter. But not the actual surgery...so make sure they send in the bills anyway!

[Rockin' Robyn 15]

I was self pay 4 years ago. I didn't ask back then as the thought really didn't cross my mind that I might have complications. Luckily I had a very kind doctor, because my port got infected and had to be removed (surgery #1), replacement of port (surgery #2), herniated tubing-where the tubing popped through a weakened area in my abdominal wall (surgery #3), needed gallbladder surgery as a result of rapid weightloss (surgery #4), herniated tubing a second time requiring mesh (surgery #5). My doc felt bad for the port infection and because I was self pay, he covered it. As for the hernia repair and gall bladder, he somehow coded them and got them covered by insurance. I'm a little frustrated now that the fills were only covered for one year, as the cost often keeps me from going in for a fill or unfill when I probably need it. Just all questions to ask and get in writing from your surgeon. All in all, I'm still glad I had the surgery and would do it again in a heartbeat! Good luck.

[onikenbai 33]

I was warned that if they had to convert to an open surgery instead of lap, additional fees may have applied to accommodate that, but band or port replacement due to defect etc was completely on their tab. If the fill nurse did stab my tubing requiring a new port and they refused, I would fight them tooth and nail, and would probably win.

Depending on what goes wrong, OHIP may pay for fixes as I have universal healthcare because I'm Canadian.

[onikenbai 33]

I'm 18K as well. It includes the surgery, the band, one year of psychotherapy, nutritional counseling, chiro & physio, and apparently they are sort of flexible on the one year limit. I get unlimited fills and unfills and general support.