Self-pay post-op insurance coverage

[goldndiamondzboy 4]

I haven't seen a thread yet discussing insurance coverage of any treatment that is needed post-surgery. Is that also exclusively out-of-pocket? I would imagine that's one of the top risks considering the relative frequency of complications.

Does that lack of coverage convey to new insurance plans? Considering that some conditions may or may not be related to the surgery, are you set-up for insurance fights for life? Thank you for your experiences with this.

[goldndiamondzboy 4]

Thank you, Bill. I guess I was really asking about complications experienced after you cross the border. From the short-term, like followup care after a serious post-surgery complication, to the long-term, like a marginal ulcer as a result of gastric bypass. I feel like I read about a lot of WLS-related complications long-term, minor or major. Does anyone have experience with insurance coverage of complications back in their home country?

Sent from my iPhone using the BariatricPal App

[friarmyth 0]

I had my surgery in the US, but I paid for it out-of-pocket. I had rare complications 2 weeks after surgery that resulted in a week's hospital stay and a lot of expensive, on-going follow-up care.

My insurance company was billed for all treatments I have received for my complications and they have not balked at payment. They've even paid for a couple of blood tests as part of my VSG follow-up-- I think because they didn't realize that the blood tests weren't ordered as the result of the complication.

I guess think of it this way: if you made the choice to jump out of an airplane and hit a tree on the way down, the insurance company would have to pay for your injuries, even though they wouldn't pay for your plane ride. So even though they won't cover your surgery, anything that happens to you afterward is their responsibility.

[Kindle 8,667]

You need to read your insurance policy carefully. Mine specifically states it will not cover any WLS including any complications from a WLS unless the procedure is a necessary, emergency life saving procedure. So to me that means being rushed to the hospital for emergency surgery cause you are bleeding out or dumping stomach contents into your abdomen. But it wouldn't cover CTs, X-rays, bloodwork, ultrasounds, scopes, stents, feeding tubes, antibiotics, Pic lines, hospital stays, etc. that are part of diagnosing and treating a leak or abcess. Fortunately I had an easy, complication free recovery and haven't needed any care other than followup bloodwork.....which insurance will not pay for.

As for a separate complication insurance policy to cover stuff once you returned home say, up to six months postop, I couldn't find any decent policies. The Medical Tourism policies covered things like death, dismemberment, some coverage while still in the other country and shipping your body back to the states, etc. The coverage offered for actual medical expenses related to surgical complications once home was minimal....like $20,000 at most, which is a drop in the bucket for any serious complications. IMO the cost of the policy did not justify the minimal pay out if I needed it.

This was over two years ago, so maybe things have changed, but like with any policy, make sure you read the fine print!

[goldndiamondzboy 4]

Thank you @@friarmyth and @Kindle. There are a significant proportion of people on here who are self-pay so I imagined there were enough people who experienced complications. I think the issue of complications down the road is a significant potential cost that may far outweigh short-term savings, particularly if this lack of coverage holds true over 10 or 20 years, and across policies.

Sent from my iPhone using the BariatricPal App

[Kindle 8,667]

Thank you @@friarmyth and @Kindle. There are a significant proportion of people on here who are self-pay so I imagined there were enough people who experienced complications. I think the issue of complications down the road is a significant potential cost that may far outweigh short-term savings, particularly if this lack of coverage holds true over 10 or 20 years, and across policies. Sent from my iPhone using the BariatricPal App

I was primarily concerned with complications that occur within weeks (or at max a few months) of surgery like leaks, abscesses, and strictures. What types of complications are you anticipating 10-20 years down the line? Vitamin Deficiencies, GERD or ulcers are the only ones I'm really aware of, and those are all fairly manageable without huge costs. The worst case scenario of any of them are so unlikely, I didn't even register it in my pros and cons. Health issues from obesity are much much much more likely to occur.

[OKCPirate 5,323]

@goldndiamondzboy-what procedure are you having? The risk of long term complications is very low for VS.

I did look into this but I found the insurance expensive for the coverage. I was very confident in my surgeon and the facility. If there was a leak it would have been discovered early while I was still there.

Look into a defined benifit policy if you are still concerned. Much cheaper than regular insurance and it doesn't have the restrictions that most regular policies have

[JamieLogical 8,713]

I simply contacted my insurance company and asked. They said any infection or hospitalization post-op would be covered. My PCP has ordered all my post-op blood work and my jnsurance had paid for it all, no pronlem,

[JoytoLose 3]

This is just a thought wrapped in a question. If your insurance won't cover complications after WLS, period, it really doesn't matter whether or not you self pay in the States or in Mexico, does it?

[Kindle 8,667]

This is just a thought wrapped in a question. If your insurance won't cover complications after WLS, period, it really doesn't matter whether or not you self pay in the States or in Mexico, does it?

Nope. It wouldn't have made any difference to my insurance company. That's why I went with the best surgeon I could find. He just happened to be in Mexico. His credentials, experience, staff, facility, and complication rate were far superior to any of the 8 bariatric surgeons I looked at within 200 miles of my home.

[JamieLogical 8,713]

This is just a thought wrapped in a question. If your insurance won't cover complications after WLS, period, it really doesn't matter whether or not you self pay in the States or in Mexico, does it?

That's exactly right. No insurance company is going to pay for self-pay complications for surgeries done in the US and not surgeries done in Mexico. They are either just going to pay for complications or not.