Self-Pay VSG

[geo16 1]

Hi -- Scheduled for a VSG in February as self-pay as Insurance would only pay for ONE bariatric procedure. Went thru the request and appeal but was denied (...had a lap-band for 5 years but had to have removed in 2010..was successful with that (68 lbs off), but now have gained 30 back in 1 year...)

My major concern is what happens if I have problems during the VSG operation or sometime down the road...will my insurance NOT pay that "just because" bariatric was performed. Has anyone had a similar story?

If insurance was paying for this, I would have no problems...I believe in the doctor and the procedure but don't want to have a lien on my house because I had this surgery...

Thanks!!!!!

[KellyL 173]

I have seen it go both ways when someone has a complication. There's been times when a persons insurance pays, and then there are people who's insurance refuses to pay for any complication related to weight loss. I think it depends on your insurance company and to know for sure you would need to ask them. I wish I could help you more, but no one here is really going to be able to answer your question, only your insurance. I was self-pay for my Sleeve in MX, so I do understand the concerns completely! Good luck on your weight loss journey!

[RickM 1,747]

There is a self-pay & Mexico board here, so you may want to cross post over there, too.

We went thru these thoughts when we self paid my wife's DS a few years ago, and our conclusion was that the insurance would not pay for complications immediately related to the non-covered bariatric surgery, so there is a gap there if the absolute worst happens. The self pay plan with our surgeon and hospital put a cap (I think it was about $70k) on the hopital stay and complications, but IIRC that only applied to continuous hospitalization after the surgery (so if she were discharged, went home and had a problem requiring more work, that was beyond that coverage) so that did put a premium on making sure all was well before leaving the hospital. I don't know how the insurance would have reacted if we had had to make an ER call in the weeks afterward since we thankfully never had to test that.

The insurance WAS willing to pay for the hernia repair that was no doubt linked to the WLS, but in typical med/insurance industry fashion, it was cheaper to self pay for it and her unapproved reconstruction surgery in a surgical center and private recovery center than to go to the network hospital for the hernia repair and add the reconstrution onto that. So, there is some window of vulnerability in the middle term (and there probably somebody somewhere that has an insurance product to cover such things at a breathtaking cost) but longer term it seems that the WLS drops into the background and becomes just another part of your medical history (that may be wrapped up in the pre-existing condition clauses of the contract - maybe someone more familiar with the nuances of the insurance contracts will chime in on this.)

On the house lien front, while it's not something desireable, it might be a good idea to establish a line of credit on the house (if all the numbers and eligibility, etc. work out), just in case - it doesn't cost much to establish it but not use it.

[GonnaLoseIt 33]

I truly wish I could help you and definately feel some sympathy towards you. I was a self pay but I live in Ontario so my health care is insured. I honestly dont know what I would have done in your situation. I wish you the best of luck, some of the advice on here is really good advice as well.

[geo16 1]

Thanks to all ... will look at self-pay forum .... many questions for the doc's office next visit. Do not want to contact insurance co. first... no use in raising a red flag!

[kykim 13]

I also was a self pay. I was sleeved last Thursday. The way the doctor here in KY explained it to me was that my insurance would not cover any cost with the original surgery, hospital stay etc. And if there were complications they would not cover it. They actually offered me a thing called BLIS insurance that for a fee would cover any complications. You may want to see if your doctor offers this. It gave me great peace of mind.

[bikerchick519 202]

Every insurance company is different. I am self pay in Mexico in a couple of weeks. I have BC/BS and they said they would cover a doctors visit as long as it didn't say follow up from the surgery on the bill. They said dr.s generally give very vague billing details and so things tend to get paid but if I went to the hospital for a complication the billing would be very detailed and when they discovered it was from a non covered surgery, they would probably not pay for it.