self payer concerned about complications

[BKLYNgal87 503]

Hey everyone. This is my first post on VST.

So in short I am in my mid-twenties and have bounced between a BMI of above 40 and below 40 the past few years. Now I am at almost 42. Because of this and lack of "serious" co-morbidities my insurance (Aetna) won't pay for the surgery. I do have what my insurance company considers less serious conditions because of my weight - chronic back pain, hypoglycemia, chronic fungal infections, mild sleep apnea (yet no diabetes yet, I know). My ultrasound was also negative for gallstones so I won't be getting any help whatsoever.

The money for the initial surgery (I will have it in the US I think because I prefer the laparoscopic approach) isn't a huge issue. I have money saved and my parents are helping me. But my biggest concern is what happens if I have serious complications? If my insurance company considered the surgery elective and wouldn't cover it, they won't pay for the costs of medical crises that occurred due to said surgery, right? I feel very powerless because I truly believe this surgery is the tool I really need to succeed in permanent weight loss. But I couldn't live with bankrupting my parents with emergency room or secondary surgery bills. What I am wondering is - what have your experiences been as self-payers? Have any of you had complications? What have the bills been like and has your insurance company been of any help? Does anyone know of any good studies out on the rates of complications with the gastric sleeve? I know that sometimes they are preventable but other times it is totally out of one's control.

Just looking for others' experiences. I know that going for surgery is always taking a chance, but I'd feel better doing as much research as possible and hearing from people who have been through it before me before I head down that road.

Thanks!!

[Chaparra 85]

I'm not a doctor, and you probably should share your concern with yours, but I think that if you follow his/her pre-op instructions, then you lessen the likelyhood of complications. I was told that I needed to lose 10 pounds before surgery to shrink my liver as that will lessen the risk of them cutting into it during the laproscopic procedure, which I just had yesterday.

[SoCalDixieGal 172]

Just an FYI majority of Mexico is also laparoscopic. But, to the insurance, get a copy of the policies legal coverages. It should be a pretty big document. My policy clearly stars that life threatening emergencies resulting from non-covered procedures ARE covered. They use plastic surgery as an example. Also, get your primary are doc on board. Mine will write any blood work or other tests as may be needed in the future.

I initially started out going to the US surgeon who did my band over five yrs ago. I was very anti-Mexico. Then the price difference was enough to make me start doing research. Just had my surgery yesterday. The facilities are great and the amount of personal care is remarkable. I'm now in a posh hotel room and will be driven back to the doctors facility daily for checks. I'm actually getting more care here than I did five yrs ago.

Definitely choose what you are comfortable, but don't let stereotypes out weigh credentials!

[blondie1007 51]

I know this is hard to hear but whenever you have surgery you are playing russian roulette with your life. I know because I have had lapband, lapband removal, gastric sleeve and two extensive plastic surgeries. I have been very blessed with all my surgeries as far as bouncing back and having zero complications with any of them.

I had my lapband surgery here in the states. I was a self pay because my insurance would not pay. I had the band for approximately three years and lost about 60 pounds with it. However, after three years it become eroded into my stomach and had to be removed. This was the worst surgery as far as pain. It was just awful. Even though the band was the cause of my problems my insurance company still paid all but my $1000 deductible to have it removed.

When I decided to have my surgery in Mexico, I went and visited with the same doctor that removed my band. I wanted to get his opinion and I also wanted to ask him if he would be there for me if I had any complications after surgery. He himself also performs gastric sleeve surgeries and is very familiar with anything that can go wrong. He also knew my Mexico surgeon (Aceves) by name and said he was a very reputable doctor and had performed many. This also made me feel better about going and my pick for surgeon.

It all comes down to choice and making a decision. With all surgeries there is risk no matter who you are. I chose to gamble and here I am 14 months out and a size 8 down from a 24. My life has changed so much and I am very blessed and thankful for it. Good luck to you.

[MichiganChic 3,262]

Regarding the insurance - Call your insurance company and ask them that question, because they already know the answer. You have some type of contract that spells out what is covered. And then get it in writing from them. Good luck!

[BKLYNgal87 503]

Thank you all for sharing your advice/experiences. Most of the reason I was scared off from the Mexico idea is my dad is an anesthesiologist and he himself does WLS cases just about every week. He is still not 100% on board with me getting surgery in general but it's more comforting to him that I have it here with a surgeon and an anesthesiologist he knows personally. But that's great to know they also do laparoscopic in MX.

Blondie1007 - wow that's so great they helped pay for the removal. I am definitely going to do my reading to see what Aetna would cover. You have certainly come a long way and I feel very inspired hearing from you.

[Christie30 2]

My doctor offered insurance for an additional charge being self paid. It is very seldom used but ask your doctor for peace of mind.

[J.Cross 37]

I was self pay in Mexico also, and had complications with my esophagus. My insurance took care of the issue. I am not saying that they would cover everything but they do cover some things.

[flmama 105]

Request a full copy of your policy and read the entire thing.

Mine only excludes treatment of.complications from surgery performed outside the US on a non-emergent basis. So basically anything you voluntarily get done in Mexico (or anywhere else) and have complications from...too bad. It says nothing about anything self pay in the US.

[KatInFL 216]

I'm sure, just like the coverage of weight loss surgery, what insurance does and doesn't cover for aftercare is very subjective.

I have discussed follow up care with my Dr, which he's comfortable providing. He also contacted a colleague in a bariatric practice who said he'd be happy to see and treat me, if I ended up needing something more complex than blood tests.

I also called my insurance company, who assured me that they are contractually obligated to cover any follow up and emergency care as a result of any surgery, whether they covered the surgery or not. So, I don't have any real concerns about what will happen after I return home.

~Kat

[bittahoney 12]

I was self pay and my surgeon included "insurance" in cost of the surgery. If I had complications and had to be admitted it only cost an extra $200 at time of admission. I did not have to do extra test due to being self pay. I did need labs and they were able to code those where insurance would help with those. Your dr should be very familiar with the coding needs for the insurance company. Although I have not needed the insurance they included in the price of the surgery I an happy it is there. The insurance covers the first year after surgery. I was sleeved on 7/25/2012 and have had no complications.

[zoekids 120]

Thank you all for sharing your advice/experiences. Most of the reason I was scared off from the Mexico idea is my dad is an anesthesiologist and he himself does WLS cases just about every week. He is still not 100% on board with me getting surgery in general but it's more comforting to him that I have it here with a surgeon and an anesthesiologist he knows personally. But that's great to know they also do laparoscopic in MX.

Blondie1007 - wow that's so great they helped pay for the removal. I am definitely going to do my reading to see what Aetna would cover. You have certainly come a long way and I feel very inspired hearing from you.

My brother is an anthesiologist and he went to MX for VSG

[d mixon 23]

In my case my surgeon included Bliss insurance into the total coat of 11,900. This will cover complications up to 60 days after surgery and covers up to 50k in fees.

[bee13 44]

Also, consider that these will be your medical bills, not your parents'. I called my insurance and they said medical problems are covered (I asked the question, "what if I got elective plastic surgery and a problem happened?" And insurance replied, "at that point it becomes a medical problem and is covered.") I didn't want them to know specifically which surgery I wanted, just in case.

[shellic 1]

The doctor I saw gave me info on BLIS - a type of insurance that covers you if you have complications. It ranged from around $225-1200 for 90 days depending on what severity of complication you wanted covered. If you had a complication, this paid for it.