self pay concerns/questions

[princess_sophie 0]

My insurance has an exclusion for any obesity treatment. So I will have to self pay if I want to get the band. My concern is, what if there are complications during surgery? Will I have to pay for all of that too? What if there are complications 2 or 3 years out? Will I have to pay for that too? What if the band needs to be removed? Will I have to pay for that too?

It would cost $17,500 to have the surgery and that would include one year post op care and fills, etc. But what about after that? If there are complications and I have to self pay for that too, I could be financially ruined for life.

Any comments, suggestions, advice? I don't know what to do.:faint:

[kacee 3]

Not sure about problems during the "installation", but I think if you have problems down the road and have to have something done that will count on your insurance as a "medical necessity" abd be covered probably. That's a guess on my part, though. I am self pay too, so am looking at the same thing.

[JLB 0]

Princess Sophie, you will have all these questions answered during your consultation with the surgeon. Ask him specifically, if this or that happens, how does your clinic handle it? My surgeon was very specific in answering my questions and concerns which were similar to yours and I was very happy with his answers. Basically, I don't have to pay further expenses for future surgeries related to medical issues but if I was to decide that I just wanted the lapand removed becasue I didn't want it anymore then I would have to pay surgical suite fees.

Good luck in your journey!

[Big As Life 0]

I am also a self-pay and I have no idea what would happen if something goes wrong...

[Bawilliams1 1]

I am self pay. My first band slipped and I paid for a new band. Now, my new band seems to be leaking! We can't find the leak under flouro, but I am going back again to try to see if we can find it if I have lost Fluid. I am hoping it's the port. I hear you can get a port replaced for about $1200. That will be another $1200 I have to cough up! What horrible luck!

[Lynette617 0]

I'm self pay and my Dr. said that anything after the original surgery that would have to be fixed is medically necessary and there's not an insurance company out there that will fight it, so it should be covered.

Find out how much the fills are after the first year so you know ahead of time. My Dr. said he codes it under something (forgot what it was) and I'll only have to pay my office visit co-pay.

I know it's scary when you think about all the things that could go wrong such as slippage, erosion, flipped port, etc. But I decided that as long as I follow EVERYTHING my Dr. says, then I should be ok. If something happens that's out of my hands, then I couldn't have helped it to begin with. My surgeon was very honest. He told me that he will not nickle and dime me because I am self pay. He thinks all insurances should pay for the surgery anyway, so he's not willing to take anymore than he has to from people who have to pay for it themselves. His surgery fee is only $5,000. It's the hospital charging $9,600 that's killing me, for 1 night. I think this is extremely too high, but what am I to do. I don't feel comfortable flying out of the country to do. If problems occur, I'd be so far away, and I hear it's hard to get a local surgeon for after care afte you've ben to Mexico. So I figure if I'm going to fork over the money, then I'm going to do it right. I'm worth every penny, and it's my body and my health I'm dealing with.

Hope this helps some. Sorry to carry on like I did, but it did take me a long time to get over the what if's of complications. You take the good with the bad, and that's what I plan to do.

[cyndilou29 0]

I went into this assuming I was paying the whole thing myself, approximately $18000 including pre-op, surgery, and 1 year of follow up visits and fills. This includes "complications", ie I had to go back in the hospital because I was swollen shut and couldn't get any liquid down.

However, even though the surgery is excluded specifically on my policy, they have so far paid $2500. Not much in the grand scheme of things but every little bit helps.

[LLSibley 1]

I'm self pay and my Dr. said that anything after the original surgery that would have to be fixed is medically necessary and there's not an insurance company out there that will fight it, so it should be covered.

Find out how much the fills are after the first year so you know ahead of time. My Dr. said he codes it under something (forgot what it was) and I'll only have to pay my office visit co-pay.

I know it's scary when you think about all the things that could go wrong such as slippage, erosion, flipped port, etc. But I decided that as long as I follow EVERYTHING my Dr. says, then I should be ok. If something happens that's out of my hands, then I couldn't have helped it to begin with. My surgeon was very honest. He told me that he will not nickle and dime me because I am self pay. He thinks all insurances should pay for the surgery anyway, so he's not willing to take anymore than he has to from people who have to pay for it themselves. His surgery fee is only $5,000. It's the hospital charging $9,600 that's killing me, for 1 night. I think this is extremely too high, but what am I to do. I don't feel comfortable flying out of the country to do. If problems occur, I'd be so far away, and I hear it's hard to get a local surgeon for after care afte you've ben to Mexico. So I figure if I'm going to fork over the money, then I'm going to do it right. I'm worth every penny, and it's my body and my health I'm dealing with.

Hope this helps some. Sorry to carry on like I did, but it did take me a long time to get over the what if's of complications. You take the good with the bad, and that's what I plan to do.

Could you possibly find out how your doctor codes it so that I can see if my insurance will pay for the fill. I'm self pay in Mexico and my fills are $100 here in the states. If I could just pay co-pay that would be really great. I appreciate any help you can give me.