Any Self Pay Patients Have Complications After Surgery?

[Lisa's Hope 421]

I was just wondering if any self pay patients had any complications after surgery and if their insurance paid for it even if they had an exclusion on the surgery itself? I'm self pay as you all know and I'm so worried what I will do if I have complications. My family has put everything we have in this surgery financially. I know I should just call my insurance company but I don't even want to give them heads up that I'm having surgery. I know that may sound rediculous. Funny thing is they paid for my physc eval. Strange isn't it?

[PdxMan 4,292]

I was self pay and I didn't have any complications, but this was one of my motivating factors to having my surgery in the US. I figured if I did have it in Mexico AND I had complications, my insurance would basically say, "Yeah, right. You had a non-covered procedure in Tijuana and you want us to clean up the mess ... right."

[donniej 35]

I went to Mexico, had complications and insurance paid for the aftercare, cant say they knew why,but they didnt ask questions. Dont ask dont tell

[Lisa's Hope 421]

Thanks guys...!

Donnie, that makes me feel somewhat better

[BrandNewMe11 1]

I was self pay too. Had surgery Jan. 23, 2012 and have had no complications. Anthem was my insurance at the time and WLS is a policy exclusion. But they did pay for my EGD, labs, sleep study, etc. HOWEVER.....the hospital billed my insurance (by accident) for the surgery three months AFTER the procedure and my paying for it. Anthem sent a letter stating they had terminated my coverage. After speaking with their underwriters, she said they will not reinstate me until 3 YEARS after surgery!!!!! This is ridiculous that they will drop a person for having to pay out of pocket for a procedure they don't cover to begin with!! So now I have United Healthcare Insurance. Under no circumstances should your insurance find out you had weight loss surgery,or you may find yourself in the same boat I was. Good Luck!!!

[Lisa's Hope 421]

I was self pay too. Had surgery Jan. 23, 2012 and have had no complications. Anthem was my insurance at the time and WLS is a policy exclusion. But they did pay for my EGD, labs, sleep study, etc. HOWEVER.....the hospital billed my insurance (by accident) for the surgery three months AFTER the procedure and my paying for it. Anthem sent a letter stating they had terminated my coverage. After speaking with their underwriters, she said they will not reinstate me until 3 YEARS after surgery!!!!! This is ridiculous that they will drop a person for having to pay out of pocket for a procedure they don't cover to begin with!! So now I have United Healthcare Insurance. Under no circumstances should your insurance find out you had weight loss surgery,or you may find yourself in the same boat I was. Good Luck!!!

Wow.. that sucks! As my husband says "insurance is organized crime!". I am now on my husbands group policy. I have a 2500.00 deductible. It hardly pays for anything. I don't think they can drop me as long as it is a group policy through a company but I may be wrong. Thanks so much for telling me though. I won't let them know anything. Hope they don't find out somehow!!

[Tibbie 55]

You are right Lisa - they can't drop you. Much of it is determined on the size of your husbands company. If it's under 50 employees, WLS is more than likely not a qualifing event. It's an exclusion. If it is covered, and the business has less than 50 employees (or even more than 50) the possibility of insurance preimums going up is a very distinct possibility - and generally the employer has no choice but to pass that along to the employees. Health insurance is just a horrible scam and so very expensive.

My husbands company has well over 200 employees. Two of them had to have by-pass surgery (heart) the same year - the next year their insurance went up so much they had no choice but to change plans, go with one where the deductable is over $5000 AND charge the employees a LOT more.

[CrazyCatLady 130]

I was self-pay for my procedure, as my employer had negotiated a total exclusion with UHC for our contract - had my procedure in Mexico with a well-respected surgeon. It always amazes me that I, as a nurse - who spends my life caring for people, can't get the heathcare coverage I need from my employers...but that's another rant.

Unknown to me (but known to my ancestors, those cheeky critters!), I had an undiagnosed hereditary blood clotting disorder, and landed back in the hospital at 10 days post op with a HUGE portal vein clot.

As far as I know, UHC has covered the one week hospital bill that I incured at that point, with no issues...other than that pesky $2k deductible.

[Lisa's Hope 421]

Thanks guys for all of you input!

[Finding Myself 146]

Would you guys mind sharing what kind of complications you had? I am going to Mexico because my insurance will not cover me no matter where I go. It sucks but that's how it is.