Success rates: self pay v/s insurance

[AZ Gary 149]

Has anyone ever seen any studies on the success rate of self pay over insurance covered procedures? In my personal case comparing it to my education pursuits, when someone else was paying for it, I didn't give it 100%, but when it was coming out of my wallet, that was totally different and I aced all the classes.

[CHEZNOEL 4,061]

I have seen no studies about it, but I was the same in college and I was self pay on the surgery.

[Cwalband 215]

My insurance is covering my surgery %100.. and it has taken me an entire year to jump through hoops to get approval. I've never been more serious in my life about anything.. but I can see what you mean. I'd like to see a study like that!

[LosingAimee 21]

I'm a self pay as well, and I've financed it for the next 24-36 months. I feel like it's given me tremendous pressure to make sure I stay on track. I can't allow myself not to make the most of something when I'm still making payments for it.

[labwalker 1,177]

I'd like to see studies done that do a breakdown of failures year by year. I realize that being recently banded means my success or failure data won't be meaningful for another several years.... but I do believe that recent surgical techniques have improved the success rate over what was achieved ten years prior.

[DELETE THIS ACCOUNT! 12,703]

I don't think how it's paid for has any relevance. It is about how committed the person is to being successful. I've seen people on both sides of the payment fence fail miserably because they simply didn't do what was necessary to be successful.

For the record, my insurance covered the surgery and I've lost 215 pounds in 17 months (and still losing).

[GuyMontag 1,264]

I think where you have it done probably has more impact than how it was being paid for. Sure, paying for it yourself might give you motivation but if you are banded at a place that offers poor support it doesn't matter how much you did or didn't pay, you are going to have a harder time. I do see that many places that take insurance are hospitals that do a poor job of follow up. I can't tell you how many people I've met that have been banded at hospitals that offer almost zero aftercare in the way of support or food guidelines and the people live on Cereal and Soup and struggle to lose the weight which is sad.

[DELETE THIS ACCOUNT! 12,703]

I think where you have it done probably has more impact than how it was being paid for. Sure, paying for it yourself might give you motivation but if you are banded at a place that offers poor support it doesn't matter how much you did or didn't pay, you are going to have a harder time. I do see that many places that take insurance are hospitals that do a poor job of follow up. I can't tell you how many people I've met that have been banded at hospitals that offer almost zero aftercare in the way of support or food guidelines and the people live on cereal and Soup and struggle to lose the weight which is sad.

I couldn't agree more!

[dawalsh 919]

My insurance paid all but $1,000 of my surgery. I have never been more committed

to losing weight insurance or no insurance. I was ready to self pay but my doctor considered my WLS as medically necessary.

I am so committed to losing weight more than ever now.

[beanie80 146]

I am paying for my banding 100% our of pocket. My first bachelors degree was paid for by my parents 100%. I paid for my second bachelors degree and my masters 100% by myself. I really think it depends on the person. My parent's raised me to know how lucky I was to have everything I had and I would be a da*n fool to waste the opportunities I had been given. I worked just as hard for the degree my parents paid for as I did for the 2 subsequent degrees. There are people who pay for their own degrees and p*ss away their time, money and opportunities also.

That being said, I think it is about how bad you want it, who you are as a person, and not who writes the check at the end of the day.

[gigglypug 77]

What an interesting topic! It kind of goes with another thread I've seen around here, which was examining the pre-op "hoops" people had to jump through before getting the band which were consistently much more involved for insurance patients than for self-pay.

Which is curious, when you think about it...insurance companies have to pay for all those extra tests, studies and services, too and so they are increasing their cost....unless a sufficiently large amount of patients gets "weeded out" by this process to be a cost incentive.

Clearly, not all of these pre-op tests are medically necessary for ALL patients, so why are they being performed standard on insurance patients to such a high degree? Is it the docs "milking" the insurance companies? Is it the insurance companies delaying surgery as much as possible in the hopes that patients just give up and go away? Not sure, but there certainly are differences...

For me, it wasn't about motivation but about control. My insurance does cover WLS, but they were very specific on who could perform the surgery. Their choice was a group that was headed up by a very established surgeon, but that also included 4-5 less experienced surgeons...and I would have had no choice in which one performs the surgery. Add to that that I would not have been able to even MEET the surgeon until my insurance approval came through and the whole thing looked way too impersonal and mechanized to me. Installing a lap band is a little like making a baloon animal inside someone's abdomen...and success, in my mind, is much more dependent on the surgeon than on whether it is a 10 cc or a 14 cc or a Realize band. I was not about to outsource that decision.

I don't know whether my insurance would have demanded the 6 month supervised-diet thing, but this to me is the most atrocious requirement of them all. I can lose ALL kinds of weight in 6 month, that is not the problem, that has never BEEN the problem. Like many people on this board, I bet, I'm an expert dieter. Problem is that by month 8, it's all back (usually bringing some extra friends). What a waste of time and resources THAT exercise would have been.

Unfettered from insurance requirements and dictates, my self-pay surgeon could personalize my treatment plan. With the exception of high BP, no health concerns, BMI of just over 40 and liver enzymes came back normal = no formal pre-op for me! Yay! I hate to hear about docs that prescribe two weeks liquid diet pre-op for every single patient! I'm sure that this is medically necessary in SOME cases, but in many instances I think it's just torturing fat people. And that's just NOT NICE.

10% of the mass of a healthy liver is glycogen (also called animal starch). These are stored carbohydrates that get transformed into glucose (the brains preferred fuel) very quickly. But because it is a rather inefficient form of storage (there is a lot of Water involved and per gram of glycogen you get a lot less energy than per gram of fat) it doesn't last very long. A few days of low or ultra low carb diet (solid food and all) will deplete glycogen storage easily. So why all the excess liquid dieting? Post-op it's necessary and for most people not that hard since the band/swelling really help at least the first week or so...

Sorry, I'm ranting. But there seem to be very different standards of care out there...and while I agree that you should follow your surgeon's advice at all times once you pick them, I do think people should pick their surgeons VERY carefully...

[emeryhns 30]

I don't think how it's paid for has any relevance. It is about how committed the person is to being successful. I've seen people on both sides of the payment fence fail miserably because they simply didn't do what was necessary to be successful.

For the record' date=' my insurance covered the surgery and I've lost 215 pounds in 17 months (and still losing).[/quote']

Completely agree!!!

[☠carolinagirl☠ 18,721]

no matter who pays, insurance or yourself

for it to work, one must adhere to a lifestyle change..and stick it out

[lellow 1,713]

Anecdotally I can see why people may think if you didn't pay for it, you wouldn't be committed, but I think in this case, it's really such an individual thing. My insurance paid for it, I didn't have to jump through any hoops or anything, in fact I called my surgeon for the first time on the 4th July and got banded on the 1st August (I'm in Australia, so I 'qualified' just by having a BMI over 35) and I believe I'm a successful bander (lost weight relatively quickly, kept it off for 3 years, kept most of the weight off despite a complication, and am back to living the 'banded' life now)

Commitment is for an individual to have. Some may be motivated by the money they spent, but I suspect that if someone isn't motivated to lose weight and improve their health, no amount of money spent is going to change that.