What are the differences for a cash-pay patient?

[Phynale 9]

After many years of trying to get my insurance to pay for weight loss surgery (even though it is specifically written in my policy that it's not covered) and getting bigger and bigger with less and less mobility, I have finally decided that I need to just bite the bullet and pay for surgery myself.

I just noticed in another thread that I need to think about what I would do if there are complications if my insurance would not cover that?

I'm also wondering if I'm crazy to get it done here in the states when it seems it is 4 times the price for gastric sleeve surgery than if I went to Mexico?

Are there any other aspects of being a cash-pay patient that are different than when insurance pays for it, both negative and positive?

[LetItGo 73]

I was self pay and part of my price ($11,900) was $50,000 in Complication Insurance (which I ended up having to use, but that's another story for another time). I did not have to see a Psychiatrist. I was required to sit through one 5 hour Nutrition Class ($80). I had an initial consultation with my surgeon and a pre op appt. My initial consultation to surgery time was two months. My post op visits are covered for a lifetime. I have BCBS and they probably would have covered my surgery due to my co-morbidities but I did not want to go through their 7 month weight loss program. I'm 52, I've been overweight for 12 years and I had made up my mind to move forward. If you have any questions, send me a message.

[AvaFern 3,516]

I was cash-pay. I had my surgery done in Florida and it was $19K. I paid an extra $1100 for complications insurance, which my doctor was a complete jerk about actually letting me use. My only complication was that I was insanely sick and another day in the hospital would have been helpful. He gave me a huge attitude because I get the idea that he is penalized if I actually used the insurance, so I just went home. Your regular insurance won't cover complications so make sure you add the extra coverage.

Past that I went to the group meeting that discussed the procedure, I had my first appt the next week with the surgeon, I had to sit through a half hour session with a nutritionist who basically taught me nothing, then that same day I had my second appt. I then paid for my surgery and 1 week later I was in the OR. From the time I decided to go to the orientation session to the time I had the surgery was a little over two weeks. I was in the hospital for three days. I then had a follow-up with the surgeon 3 weeks later and that was the last time I was ever in that office. After 3 months generally the price to see the surgeon is astronomical because your insurance doesn't cover follow-up.

If you choose a good surgeon near where you live you will be unlikely to have any complications. I have heard there are plenty of great surgeons in Mexico for 1/4 of the price. Overall by not using insurance you go through the entire process much faster, but if you end up with major complications and you don't have that extra coverage you purchase for the surgery, everything else is out of pocket.

[Dub 9,922]

Self paid.

Done in my hometown by an excellent surgeon through a Center of Excellence accredited facility.

~$20K and that included complication insurance.

Zero regrets other than wishing I'd done so sooner.

[OKCPirate 5,323]

Self pay in Mexico. I loved the service, I see why their infection rates are so much lower than in the US. They don't do crap we do in the US mainly to cover their butts in case of lawsuits. Bigger rooms, less equipment means fewer places for germs. They mop three times a day. I picked a great surgeon who also teaches in the US. It is a great option if you:

• Can self educate on nutrition and care.
• Have no risk factors (drugs, blood pressure, heart, liver problems).

So for less than $5000 was able to get it done and the results have been great.

[momofmanyready2bskinny 6]

I was self pay and part of my price ($11,900) was $50,000 in Complication Insurance (which I ended up having to use, but that's another story for another time). I did not have to see a Psychiatrist. I was required to sit through one 5 hour Nutrition Class ($80). I had an initial consultation with my surgeon and a pre op appt. My initial consultation to surgery time was two months. My post op visits are covered for a lifetime. I have BCBS and they probably would have covered my surgery due to my co-morbidities but I did not want to go through their 7 month weight loss program. I'm 52, I've been overweight for 12 years and I had made up my mind to move forward. If you have any questions, send fb w

[Phynale 9]

^{Thank you everyone for your responses. I am so new to this and did not know realize how little research I had done prior to now even though I thought I had. It's funny the closer you get to actually doing something, the more interest you have in the details.}

^{My son has several friends who have had this done and I'm going to ask him to ask them if anyone had it done in Mexico. Though I know he would be totally against it since I would have to go alone.}

^{Speaking of which, I think that's one of the scariest parts about this is that I really need to be able to be self-sufficient as much as possible. Can you take care of yourself once you are sent home from the hospital? In the words of the wicked witch, and my little dog too? Will I be able to take my dog out on my own as soon as I get home?}

^{As for the hospital stay, from what I'm reading it sounds like if there are no complications that I should be able to leave pretty quickly. I know I'll find out more details once I actually go in for my first consult.}

^{I am so excited and scared at the same time. I'm so glad this board is here. I'm looking forward to learning more and more from those of you who have been there.}

^{And yet, I'm scared something is going to get in the way of me actually getting the surgery. That is one thing that being self pay seems to help, there being less obstacles. I've recently been having knee pain but do not want to do anything about it so I can see if it helps for me to get some of this weight off of it before I consider anything serious for the knee.}

^{Sorry for the rambling. Again thanks to every one of you for your advice.}

^{Edited to add: I don't know why I can't make the font any bigger. I tried highlighting my post and selected size 12. Sorry.}

Edited December 27, 2015 by Phynale

[artgoddess1974 3]

I am a self pay patient in Memphis, TN. I paid $19,500 for gastric bypass on December 2nd. I was never told ANYTHING about complication insurance. I didn't even know this existed. My surgery was done through a Center of Excellence, so I still had to meet a few requirements that they have people using insurance complete. Overall I met all the requirements (nutrition class) and saw all docs (psych, cardio) and had a surgery date within 2 months.

[Cutepretty1 121]

I was self pay Memphis, TN as well. Approximately 15k for gastric sleeve at COE. Attended 2 classes, psych, blood work, and EGD which was done in April. I could have scheduled surgery within 2 weeks after initial visit but waited to Celebrate my and significant other birthdays. I was concerned about complications but I prayed about it and left it in God's hands. So far I am 6 weeks and have been doing well.

[aaonthego 24]

I was self pay in Cincinnati. $14,700. No complication insurance included but like the previous poster, I prayed about it and left it in Gods' hands. You might consider calling your insurance company up front and asking them if they cover complications from elective procedures not covered by insurance. I understand some plans do, but I chose not to involve my insurance company because I didn't want the added stress or nervousness if it wasn't a positive answer.

[kim36517 3]

I was wondering who your surgeon was? I am looking at self pay.

[artgoddess1974 3]

Where are you located?

[LiMurr 24]

I'm in CT and getting sleeved on Monday (very excited!). I decided to self-pay because I have a relatively low BMI and knew that the insurance struggle would probably take a year, and I'm just not that patient.

My surgeon's fee includes BLISCare, which is essentially insurance that pays for any complications related to the surgery. I would definitely make sure you have something like that in place.

I considered going to Mexico. If I did, I was going to go through the Bariatric Pal program. Based on my research, I thought they had a good group of surgeons that were thoroughly vetted. The only reason I didn't go that route was that I was concerned about follow-up care. My PCP isn't completely on board with me having this surgery, so I wasn't confident that I could rely on her to help with the required blood work, etc. Even with having my surgery here, getting my medications switched to powder/liquid has been a real nuisance. My surgery is Monday, and I'm still trying to finish getting one of them squared away.

My initial appointment with the surgeon was the last week in December, and my surgery is Monday, so start to finish it was about a month. In that time I met with the nutritionist and social worker on staff. The social worker was really great. Helped me get some really good insight into my relationship with food that I hadn't previously thought of.

What I was pleasantly surprised to see was that when the surgeon, nutritionist, and social worker submitted those visits to my insurance, they were paid. I think what happened is that they were looked at as just regular office visits, not connected with the surgery, which my insurance company doesn't even know about. So there really wasn't an opportunity for them to deny the claims based on unapproved surgery. I don't know if I explained that well, but my point is that you might as well let them submit these visits to insurance and see what happens. Worst case, they don't pay.

[CanadaLoser 80]

I'm going to Mexico as well. I have spent the equivalent of WEEKS researching this and am confident with my decision.

Check out the Mexico area of this Site, tons of great info there

[Riz2006 242]

Self pay - $28k in Ohio by an excellent surgeon at a Center of Excellence.

My dr makes his self pay patience follow the 3 month NUT, see psychologist, all the lab work, etc.

I was not offered the complication insurance.

No regrets! Best money I have ever spent!