new to posting

[taylorrae9 0]

Hello everyone,

Thank you so much for all the information you all have posted because it has been really helpful to me in making my decisions. The decision to have the lapband instead of the Gastric by-pass was easy but now I am not sure how to proceed. I am hoping that someone might have some ideas to help me.

I met with Dr. Jossart from San Franscisco and he advised me that the lapband would be my best option and that my insurance would cover it. Also that I would most likely need to have my gall badder out at the same time. I did all the pre-opt tests and called to see when surgury could be. But they said thay they called my insurance and I was told that my insurance has an exclusion for weight loss surgery which I knew but was told they had been able to have the surgery covered for other patients. I was advised to try and go through my HP department but that they have not covered the lapband historically and would most likely not. I am able to get the gastric by-pass through Kaiser but really am afraid of the surgery.

I was cautioned not to go to Mexico by my primarycare doctor, Dr. Jossart and my ortho doctor. They all said that the care was inconsistant and risky. I am uncomfortable with charging 12,000 and think 8,000 is a much better deal. I also asked if I could pay the difference between the gallbladder and the lapband but was told I would be charged 6500 from the hospital so they would be paid twice for the services. It just seems unfair to charge doublebut I am unsure how to approach this.

Again, thank you all and I am amazed that there are so many people who have gone trhough the surgery and are doing so well.

Thanks,

Melanie :banana

[New Hope 37]

Melanie, have you thought to appeal your insurance co. decision? Why will they cover bypass and not the band? You may be pleasantly surprised. Are you saying it would cost you yourself $6500 to get your band locally? And the insurance would pay to have your gallbladder removed? That's 2 separate surgeries you're going to have to go through, if you get your band done elsewhere. Comparing your costs, wouldn't it be cheaper and more convenient to have your band placed locally and receive your aftercare locally? Best of luck to you as you research all your options!

[taylorrae9 0]

Thanks Marie,

My insurance will cover 70 percent of the MD for the gall bladder and 90 percent of the hospital. The lapband done on the same day will cost an additional 6500 for the hospital and 6000 for the doctor. So my costs could be over 15,000 all said and done.

While Mexico is cheaper.

I don't think I was clear. I was hoping to have the costs combined and pay for the band and a bit more but not twice for the same day.

Thanks for your help.

Melanie

[New Hope 37]

Wow, I'd have to double check on that one! I assume you'd be using the same surgeon for both surgeries, done at the same time in the same o.r., and you'd be in the same hospital bed 1 night. That can't cost you twice as much for what 15 minutes more operating time! Plus you'd only have to go through surgery and recovery once. Please check directly w/ your surgeon. Best of luck to you!

[Marimaru 7]

While you definately might want to consider fighting your insurance on this one, I don't know why your doc would say what he did. A number of us on this board were banded in Mexico, and many of us like our Mexican doctors more than any doctor we've had up here. I used Dr. Rumbaut in Monterrey and I have nothing but good things to say about him. I'm also pretty sure that I read in my documentation from him that if you go in for the lap band surgery, they'll remove the gallbladder (if needed) at the same time at no additional cost. You may want to confirm this, but I know I read that somewhere. Doralisa is his patient coordinator, and this is her email address: doralisa@gastricband.com. She'll answer any questions you have, she is so great.

Keep us posted on what you decide to do. But I would suggest that you don't 'settle' for the bypass if that's all your insurance covers...

[taylorrae9 0]

Thanks Marie and Sarah,

I will talk with the office and then the hospital to see if they can pt it all in writing and submit it to the insurance office and then if it is more than I can afford I will go to Mexico.

Do you pay more when you go through a coordinator? This is what I was told that it costs about 1,000 more then calling the office directly.

Againm thanks - putting it all on paper made me realize I have some serious stuff to check into.

Melanie

[taylorrae9 0]

Hello Everyone,

I just wanted to give you a quick update. After speaking to my insurance company, hospital adminstrator and my doctor's billing department I was told I would have to pay about 12,000 - 14,000 for my lapband and that the gall ballder surgury would be "carved" out but in no way would they be able to adjust the fees for the amount they would recieve for my gallbladder removal. It seems that they have cut costs as much as they feel they can and historically they have tried to adjust this but have been unsucessful. Everyone cautioned me greatly about going to Mexico claiming they have had clean up they work done to people who have had no abilty to sue for damages done in Mexico.

At this point, I was told that I should wait for the new band that will be released next year which will force down the costs here in the US. I am really disappointed but will keep looking into other insurance or something.

I thank all of you and have learned so much reading all the posts late at night.

Thanks,

Melanie

[leatha_g 4]

Taylor,

I'm sorry for your disappointment. I know insurance issues can really be a bummer, but please do not give up on Mexico. There are a handful of shady characters in Mexico that you shouldn't trust, but by and large most of the Mexican docs are far more experienced with the band and operate very legitimate, caring, qualified and clean office/facilities. Most of these guys actually train the US docs who have and are now learning to install the bands. Most of the people I know who've been operated on in Mexico absolutely love their docs and trust them with their lives. I was not personally banded in Mexico, so I have no stake in saying any of this, but it's my opinion that you are far better off with some of those guys than many many of the new less experienced docs in the US, especially if you are going to have to self pay. Don't give up! You can make this happen if you truly are determined to make it happen!

Good luck to you!

[New Hope 37]

Melanie, best of luck to you on your search for better health! Please don't give up! Research everything you can get your hands on - about the band, drs., and their aftercare. I don't know how far you are from Mexico. But that is one thing that some people aren't taking into consideration, their aftercare, cost of fills, travel, time off work, hotel, food, taxi. There are several Mexican bandsters here who love their dr. and care. I was denied, appealed, 8 months later got my band locally. Just please remember that this weight didn't appear over night and try to be patient as you figure out what to do.

[La_madam 20]

Its too bad your Dr's discouraged you to got to Mexico. The band Dr. I met with here in California is the one who reccomended Dr. Ortiz to me. Dr. Ortiz was the Dr. who trained him. More Dr.'s in Mexico have more experince and have placed more bands then most Dr.'s in the US. The hospital I stayed at was very nice and very clean, the hotel I used was a 5 star hotel, and the was no language barrier with the hotel, the hospital staff, Dr. Ortiz or his entire staff. I understand your frustration because my insurance does not cover the band either and even if they did I would of had a hard time getting approval, I was basically a healthy fat person. No co-morbitities whatsoever from my weight. After researching it here in California and seeing how much it would cpst for a self pay here in the states and after Dr. Ortiz coming highly reccomended from a US Dr. ...was sold and went to Mexico and do not regret it for one single second! Today is my 7 motnh anniversary from surgery and I have lost 62lbs as of 11/1.