Self Pay Patients Who Had Complications....who Pays?

[skeedr 0]

Hi all! Question..... for those that were self pay and had developed complications did anyone have success with their insurance companies paying for the complication? Did you go to original surgeon or if you were an out of state patient did you use local?

Thank you in advance:)

Heather

[adorkbl 156]

I am self pay. I was banded in Colorado by Dr Kirshenbaum. My surgery was $9995, not including airfare/travel expenses from Arizona.

I started having problems about 1-2 months after surgery and ended up in the ER 3 times trying to figure out what was wrong and if it was band related. I had 2 CAT scans, an Upper GI, an EGD, 3 ultrasounds, and finally a HIDA scan. All of the tests were covered by my insurance except for the EGD. I had to go out of network for the EGD since I was doing my follow-up care with a surgeon in Flagstaff (4 hours from Tucson where I live). It ended up being my gallbladder. My gallbladder surgery was paid for by insurance.

Then I had problems with a leak in my port. I was in and out with fills for awhile before we determined it was definitely a leak. I paid for all those out of pocket with my new aftercare surgeon (who I found when he removed my gallbladder). I pay $100 for a fill with him. I have had approximately 24 fills and 8 unfills over the last 4 and a half years (a lot during the time I was diagnosing the leak).

I ended up having my port replaced last year. My surgeon did it under local anesthesia for me so I could save the cost of a surgery center and anesthesiologist. I *think* that cost me approx $2200. I would have to look at my records.

I had another EGD done this year to diagnose a hiatal hernia. That was covered by insurance but my co-pay and co-insurance was approximately $800. Now I am scheduled for a hiatal hernia repair and band repositioning surgery. Luckily my surgeon's office got my insurance to approve the surgery as a covered expense. I thought the band repositioning was going to be my expense due to an opt out clause by my employer for bariatric. Since the band has to be repositioned to do the hiatal hernia repair, they are covering it. I still have co-pays on the surgery that will end up costing me approximately $1300 out of pocket. It would have been more but my yearly out of pocket maximum will be reached.

Honestly I am afraid to add everything up to see just how much this lapband has cost me!! I did NOT expect so many things to pop up. I am "lucky" that my insurance has picked up a lot of the bills... but my co-pays & co-insurance are high. And if it was explicitly band related (like port revision surgery) I was on my own!

If I had to guesstimate… I would say my lapband has cost me at least $20000 at this point, if not more. If I knew that going into this, I wouldn’t have done the surgery. It has been a burden financially to my husband and me.

[Fantasy 104]

I have read some real horror stories about people who went to Mexico had, weight loss surgery, then had compllications and their insurance wouldn't pay for it. I would call my insurane co. anonymously and ask this question. This can be a sticky situation.

[SamiB 0]

I had my band done in Mexico in 2007, in May '12 I had to have the band removed due to severe erosion, my insurance covered it according to my plan, even all the tests to find what was wrong, I guess it just depends on your insurance. Just call and ask them, when I called me having it done in Mexico never came up. My insurence would not cover any bariatric surgery though, but covered the removal due to erosion.

[Hopec 0]

I just had surgery to repair my lapband. It was suppose to be simple. I a cat scan first to look at things and the disicion was made to reconnect the tube to the band, or replace the port. My surgeon moved the port which had no hole, then filled it . The Fluid squished out of the band so he just closed me up.This wasy original surgeon. My insurance was covering 1 surgery per lifetime. That's what I got. Nothing but broken parts in me. Advise read the fine print . Malle sure your surgeon will fix whatever is broke. Was a self pay the first time , so I have lost over 20,000.00 and am very depressed.