Self-payers and $$ for complications

[momlambert 77]

Hi all. I'm so upset because my surgery is scheduled for March 18 and DH just called the insurance (which isn't covering the sugery) and found out that any complications won't be covered in the future, since the surgery isn't covered. I understand that and was willing to pay for surgery for a slip, etc. if absolutely necessary BUT DH is worried about even greater expense--like what if I end up in a coma or something???? What to do? How have you reconciled this? DH seems to feel that it is a risk we shouldn't take but should wait 3-4 years until we have insurance that will cover it. I'm almost 58 and don't want to wait. We're using retirement money so I understand this is a big problem but I'm just so sad about possibly having to wait. We'll discuss it tonight but I wondered if anyone could provide some insights, stats, experiences, etc. that might help with my decision to go forward and take the risk or withdraw and be fat for another few years. Help!:help:

[marjon9 6]

I do understand how your husband feels but when you weigh each side of the equation the support for waiting 3 or 4 years just is not there, especially at your age. On one side of the equation there is a very, very small risk of serious complications like a coma that could be expensive. On the other side of the equation is all of the following: dramatically improved quality and enjoyment of life, significant increase in life expectancy, resolution of obesity related health problems that you very likely have now (diabetes, heart disease, high blood pressure, knee and ankle problems, sleep apnea, etc., etc.). This really is a no-brainer. Choosing to live out your remaining years as a cripple because you are afraid of a very tiny chance of something serious happening is just not a good choice.

Spouses often have a hard time when their other half makes a major change. My wife resisted the lap band surgery for all kinds of reasons. She was mainly just afraid that a major change in my life could mean a major change in her life. I think some of that may be going on with your husband. I think he is a little bit nervous about you becoming a happier, healthier, more active person. That's understandable. But I really think that the resistance you describe about the possible cost of a coma is really not about the coma, but is more about the change.

[momlambert 77]

Thanks, Mark, for your quick reply. I feel the same way you do about the risks of waiting but I really need DH's support through this so further discussion is certainly necessary. I called my dr.'s office today and asked them how often someone has to be taken from the surgery center to the hospital because of complications. They said they have never had that happen. That's comforting but doesn't mean, of course, that it can't/won't happen. This is so hard to deal with when I'm in such an emotional state now riding the roller coaster with all the self-doubts, hopes, concerns, etc. that come with this decision. It's not a good night.

[rondajs 0]

Mark, your insight certainly has helped me. DH was the one that told me about the procedure a couple of years ago. Now that I have decided to do it, he starts acting all nervous and starts with the "what if" questions. I thought he would be much more receptive than he is. I am so crazy in love with him, why would he have anything to fear? I have to figure out how to ease his mind that this is so he has a healthier wife and our children have a healthier mother. I fear that if something isn't done now, that I may die an early death and leave him with 3 young girls to raise on his own (which is one of those "what if" questions.) Thanks for the information.

[lianna 3]

Have you had a consultation with a doctor yet? If you are truly considering lapband surgery it would benefit you and your husband both to get the facts and do some serious research on this procedure. The chances of complication are very slim, and a coma is something I have never heard of happening. Ever. If you take the pretests, and you are determined to have no underlying conditions that would make you a poor candidate for the surgery, this is no more life threatening or riskier than gall bladder surgery. I think like the above poster said your husband is just having cold feet for other reasons...which is understandable. This is an elective surgery that requires anesthesia, but it is still comparable in severity to having your appendix out or gall bladder removal...the chance of coma or death are virtually zero.

[lisah25 3]

DH and I were both self-pay, and this was a concern. But in doing the research, the risk of a serious complication is pretty slight, where as the risk of serious health issues if we stayed MO was very high. Also, where we had our surgeries, they cover any band complications. Except for the anethesiogist(sp?) fees.

[robinlwade 0]

You need to call your insurance company again you got me thinking so I called mine that was not the case they wouldn'tpay if it was done in mexico,if you go to your pcp and have the lap work done and xray your insurance company will pay for it the problem with me is noone told me that before because my lapband dr didn't let me know it wasn't cover in my 17,000.Find out what blood work needs to be done and take it to your pcp have them do it and send it over to your lapband dr.But you need to talk to your pcp get his support let him know what is happening, I wish I had done that. But you need to talk to the insurance company.

[momlambert 77]

Thank you all for your insights. We are still talking and figuring (and crying some, too). I'm sure it will work out one way or another--hopefully with me happily going into surger on March 19!

Just to be clear and answer your questions: yes, I have done lots and lots and lots of research. And, although we understand that the risks and complications are minimal, they do still exist. And therein lies the rub. If you are the ONE of the 10,000 with the complication, it doesn't matter how many others didn't have complications. Complications, I can live with. Spending our retired years paying the medical bills from those complications is an entirely different story. BUT, they are rare and the question is whether or not to take the risk of potentially catastrophic costs if there is a serious complication.

My dr. does pay for any complications related to the band (slippage, erosion, etc.) during the first year as well.

I have had all the blood work done (covered by our student insurance--DH is working on a PhD in math now that he retired) and my pcp is very supportive of this procedure.

I think that answers your questions. The points I like best that you provided is that the complications of being overweight far outweigh (pun intended) the possible surgical complications. I want to hold on to that. Of course, the complications of obesity are payed for by insurance! Go figure. Something is wrong with this picture.

DH just said that he "isn't comfortable doing this without insurance" but when I asked him how likely he thinks it is that I will be having the surgery on March 19 he said, "about 97%." That give me great hope as I thought he would say "less than 1%." He assures me of his love and his admiration that I am willing to do this (he married me at 117 lbs. 39 years ago) but, since he wants us to live a long time together happily, he needs to consider all of the possibilities that might interfere with that dream. Of course, one big interference is death from obsesity. Another is losing our home and retirement because of medical bills. It's a gamble either way.

Thanks for your insights--I read DH your comments and I do think it helped. Karen

[lisah25 3]

DH just said that he "isn't comfortable doing this without insurance" but when I asked him how likely he thinks it is that I will be having the surgery on March 19 he said, "about 97%." That give me great hope as I thought he would say "less than 1%." He assures me of his love and his admiration that I am willing to do this (he married me at 117 lbs. 39 years ago) but, since he wants us to live a long time together happily, he needs to consider all of the possibilities that might interfere with that dream. Of course, one big interference is death from obsesity. Another is losing our home and retirement because of medical bills. It's a gamble either way.

We had almost the same conversation almost 3 years ago now, only DH wanted the surgery and I was worried about un-insured complications. It worried me a LOT. But then our doctor told us that if DH didn't lose weight, he wouldn't be here in 10 years. Scary when you are 41. So, in a way it was much less a gamble for him.

For me, my health wasn't that bad. My surgeon said my health history was boring! But I couldn't do the things I wanted. And since I'd tried everthing more then once, I knew I wasn't going to do it without surgery.

It does sound like you and your DH are able to talk things through, and be honest with each other, that's a very good thing.