Insurance Hoop Or Self Pay?

[beefalogal 43]

I have always hated that insurance requirements are so rigid. I have Aetna and they will approve the procedure but the copayment is nearly as much as the price in Mexico. Am I being crazy and inpatient to consider just going to Mexico and being done with it? I have done the sleep study (used a cpap now or twelve years but they did say that I need to increase the pressure considerably). Doctor is requiring a new endoscopy and I had one eighteen months ago. Still need the psych exam and three visits with the NUT. Anyone else considered this?

[Wheetsin 714]

All things being equal, I would stay in the states. There's more to consider than cost.

• Don't have to search for an aftercare provider, should one be needed
  
• Like not having to mess with travel
  
• Like that I could get home quickly
  
• Like that I have post-op visits/long-term care with my actual surgeon who's most familiar with what happened during my procedure
  
• Some prefer the MX surgeon histories. I selected my surgeon and am more comfortable with his history
  

I'd say keep trying through insurance, but maybe set a date at which you look at your other options. That's what I did - it all ended up working out, but I wasn't going to just sit around forever.

All things not being equal, my first choice was to self-pay my chosen surgeon's rates (about $12K).

I was initiall denied by insurance, appealed and won, then insurance changed and I was back to square one... I'd started working on this in September 2011. When it was Jan and nothing had happened yet I talked to DH and we agreed that if I didn't have an approval by March 31, we would just self-pay and not worry about the insurance. But that's a different scenario, because $12K is much higher than my copays (totalling about $400), and much higher than a MX surgeon.

[PdxMan 4,292]

$10,400 for VSG in Las Vegas (baby!)

No hoops at all.

[lil lee 46]

Yep that's why I'm going to Mexicali.. My deductible with blue shield is $5000 plus after care of $3000 not covered by insurance so you can call dr anytime 24hrs a day "this is just my dr's thing" shouldnt I be able to call the dr whenever without paying after he did surgery!!! and must be paid when you schedule surgery. so that's $8000 not including what insurance pays and in Mexicali it's $8750 for everything and my PCP is doing all my labs and he faxed them to Mexico for me including my ECG I had done and he will do my after care labs..

[emptynesterpam 13]

Yup. All of us who couldn't get the insurance company to pay for it took matters into our own hands. There's plenty of folks around here who have gone to Mexico' date=' and they can relay who they like so that you can make an educated decision.[/quote']

If we go to Mexico for the surgery, and come back having complications, will insurance pay to see a doctor...even if we had surgery outside of the country?

[Wheetsin 714]

You'll need to check with your insurance company. Generally if not covered for WLS, you are also not covered for complications.

[beefalogal 43]

I have heard from many that insurance would not cover complications but have not actually talked to ome one that had happened to if complications happened. Any that can speak up about that happening to them? Just wondering.

[Rootman 1,101]

I too have insurance but elected for self pay in MX, I simply did not want to wait 6 mmonths to a year for the surgery, I was miserable and had to get faster results. I agree it's a hell of a risk and should complications arise you might be in triuble. I did it and have had fantastic results. Only uout can wiegh the risk / reward and make your own decision.

[emptynesterpam 13]

I too have insurance but elected for self pay in MX' date=' I simply did not want to wait 6 mmonths to a year for the surgery, I was miserable and had to get faster results. I agree it's a hell of a risk and should complications arise you might be in triuble. I did it and have had fantastic results. Only uout can wiegh the risk / reward and make your own decision.[/quote']

Who did your surgery in Mexico?

[Lissa 2,631]

I self-paid in the US. $12,500 here in Florida with a local doctor who, IMO, is amazing! Mexico wouldn't have been an option for me at all because of pre-surgical complications, but many people have had great experiences there. My insurance doesn't touch WLS at all, so it was self-pay or nothing for me.

[butterbean 30]

I am self pay in the US at 16K. That includes 6 months surgery insurance. So any aftercare or complications within the 6 month window is covered.

[Rootman 1,101]

Who did your surgery in Mexico?

Almanza at Jerusalem clinic Tijuana MX. I it was $5000 total plus airfare and 2 nights at a hotel, so close to $6000 total all things considered.

[IMSKINNY 160]

@Rootman - Wow, that was steal! One of my friends is a business owner so her insurance isn't great. She's self-paying and will be skinny before me! Rattttssss! I have another appt before they submit to the insurer, but you can believe I'm thinking of self-pay and Mexico!