Differences for self-pay

[msbug 0]

I'm considering lapband surgery. My insurance will not cover it because I haven't been enrolled in our plan for 2 years (only been on it since Jan 1 of this year) and I have to have at least 2 co-morbidities, which I don't. I'm actually pretty healthy for a fat person. :nanahump: I don't have high blood pressure, high cholesterol, diabetes, chronic pain, etc. I do have asthma, but I had it since I was little and it's not weight related. I'm actually better now than I was when I was younger, despite the extra 150 pounds!

Anyway, I was just wondering if the pre-op requirements were different for a self-pay. Do you still have to have the sleep studies, endoscopy, and everything? And do all bandsters have to lose a lot of weight before they have the surgery done? I've read about people who have to lose 30lbs before they can have the surgery. Gee, if I could do that on my own, why would I be having the surgery?!

Thanks for helping out a newbie!

Tracey

[medussa 0]

I have insurance, obesity, and 3 co-morbidities and am still a self pay. I refuse to wait another year on a "Physician supervised diet" I will just be another 30lbs heavier by then. I know that all my pre op stuff was submitted and paid for by my insurance. I had 2 sleep studies, labs, CXR,EKG, Ultrasound, pulmonary function test....you name it. I paid the surgeon, the hospital and the anesthesiologist total of 8500$ All else I had submitted to my insurance and no questions asked. I will also have my endoscopy submitted when the year mark comes around. I just let the MD know I am self pay. Either he or my PCP order it and write down the code...which is not related to weight loss surgery. Meaning, i had the sleep studies to asses for sleep apnea. The tests should all be done... just make sure you tell them that the stuff like that should be submitted to your insurance. I hope that helps. Good luck!!!!!

[medussa 0]

To answer the weight loss question.... I was put on a high Protein diet for 6 weeks and a liquid diet 2 weeks prior to surgery. I was not asked to lose weight but I have lost 10lbs so far. I was told not many people lose significant amouts of weight prior. I am a little different in that I have only to lose 60lbs, but I am quite short. I have lost 10 to my astonishment despite my occasional "I have to eat everything now and get it out of my system before surgery" moments. It is not easy but hang in there!

[PhotoNut 7]

I think it would depend on which surgeon you spoke with. I was self-pay but was still required to go through all of the standard pre-tests, including the sleep study, pulminologist, and psych tests. My doctor feels that these pre-tests are crucial to determining whether or not a person is in good enough physical and mental shape to not only undergo the surgery but to also be successful with the band.

The prerequisites for being banded were a BMI of 40+, over 100 pounds overweight, or a BMI of 35+ with two comorbidities.

I believe that surgeons out of the country are more lenient about the requirements. However, before you select a surgeon out of your area or out of the country, be sure you have a doctor in your area set up for follow-up care that you can get to for fills and any complications you might incurr.

Best of luck to you.

Added: Again, the requirements for pre-surgery diets and weightloss will vary between surgeons. The pre-op diet is aimed at reducing the fat in the liver so the surgeon can safely move the liver out of the way. Fat in the liver can increase its size to the extent that it cannot be moved without risk. My Dr says the goal is to lose a certain percentage of your excess weight, but even though I didn't achieve that I did lose 16 pounds in about two weeks and he was happy with that.

[DonnaB 3]

Hi bug,

You don't need all those tests - I didn't have them. Part of the reason I was a self-pay is my insurance wanted a bunch of tests including a year-long doctor supervised weight loss study. Ridiculous. What they really wanted was for me to lose interest and go away. Even after jumping through all the hoops I've heard of people who have the same insurance as I do who were refused coverage on technicalities.

My doctor discussed my medical history and my current health, and with the information we talked about he ordered some basic tests to be done on the day before my surgery. I had a blood test, blood pressure, chest x-ray and echo-cardiogram to be sure my lungs and my heart were in good shape for the surgery - they were - and into surgery I went the next day.

Good luck on your weight loss journey.

[K@t 38]

I had my surgery done in Portugal where I live, and I was self pay. The surgeon wanted what seems to be the standard tests, a echocardiogram, chest x ray, and blood test. He did require an endoscopy which was the worst, but not all doctors do. As far as the pre surgery weight loss all the doctors are different, mine didn't ask for a specific weight loss pre surgery, but asked I do liquids one week before surgery, and he said there were no problems with surgery.

I think all the doctors are different so you should just check around and see whats available in your area.

[Tricia K. 0]

I think that you should meet with your surgeon to discuss which tests he/she may require so that you can get a better idea. However, I will answer your questions.

I was a self-pay patient, and my surgeon chose which tests for me to take depending upon my medical history and a series of questions. I had regular blood work, a psych evaluation and then an EKG a few days prior to surgery. Nothing more, nothing less.

My surgeon also requested that I lose at least 1-2 pounds prior to surgery to reduce any fat I may have had around my liver. Some surgeons require more weight loss, some surgeons require none. My surgeon said that even 1-2 pounds would make the world of difference to him while I was on the operating table.

[MelodyJ 0]

Tracey,

I was self-pay. I had about as much to lose as you. Initially I thought my insurance was going to pay...they did not. Anyway, as someone else said you can get your primary care dr to order the basic labs, UGI (barium swallow), and EKG under your insurance w/ proper codes. I did not have to have a sleep study as I was negative on the questionnaire they had about obstructive sleep apnea. The surgeon will determine what you need to have done. I did not have to go on a diet before surgery except the day before and he didn't want me to pack on all the food as a "last meal" effect I believe!?!?! My dr (Dr. Ponce in Chattanooga,TN/Dalton, GA) said I was the perfect candidate because I didn't have the co-morbidities! I did do a psych test....just a written questionnaire and they never told me any problems w/ it?! I think being self-pay lightens the load of jumping through the hurdles of insurance stuff!

Hope this helps!

God Bless,

Melody

Banded 3/20/06 -43lbs

[Iluvharleys 15]

I was a sef pay and I didn't have to do any of the tests. I had to have an updated blood test, and my yearly stuff done, which my PCP had so he faxed them over and that was it.

[*susan* 1,709]

I was self pay. My surgeon did a physical on me, I had to have a psych. eval., meet with a nutritionist, have a sleep apnea test, ekg, chest x-ray and bloodwork prior to my surgery. Additionally, I was placed on a liquid diet (Physician's Weight Loss) for 2 1/2 weeks prior to my surgery.

I think the pre-tests are important to make sure you are in good health and reduce any surgery related risks. JMO.

[gordonfamily3 0]

I actually work for my surgeon now handling the insurance/ financial part for patients...so what he requires is that you still have the standard test done. Psych, Nutrition, Exercise, Labs, EKG, & Chest X-ray. The others he will only require if he feels they are needed. Check w/ being a self pay because he gives you 1 year follow up if you are a self pay. Hey it wouldn't hurt to ask. For the weight loss before - he requires a 2 week liquid diet yes to loss weight but to help shrink the liver since that is right where he is doing the surgery. You don't have to loss a certin amount.

Good Luck!!!