Self-pay patient questions

[micro_me 7]

Hi all,

I am planning (hoping) to get surgery in February of next year. My current health insurance specifically excludes WLS, but I am switching plans in January and the new plan MIGHT cover the surgery (BCBSM). I started meeting with a nutritionist in August in hopes that if my new plan covers it and requires 6 months of medically managed weight loss, I would be able to use these meetings for that prerequisite.

I met with the patient coordinator on Friday last week and told her that I want the surgery whether insurance covers it or not. I have been thinking about this for over 6 years and I have saved up, so I can do it. I asked her about complications and how much is included in the initial payment (one surgery center I spoke with covers up to 30 days post surgery with some type of 'bliss insurance' or something like that). She told me that they will cover up to $50k if there are complications and then 50% of any charges after that. She was very negative about me doing the surgery out of pocket. She basically said that I could put myself in financial ruin if I do it and that I need to think about my family and what could happen if there are complications. Does anyone have personal experience with this? Are there any ways to mitigate the risks of complication-related out of pocket cost?

What really got me though was that she said that she has had patients who had insurance-covered WLS who are now on insurance that doesn't cover WLS come back with surgical related issues (blockages, internal hernias) and since their new insurance doesn't cover WLS, they are denied coverage for these issues. Has anyone experienced this? I am thinking that with the new health insurance policies that no longer allow denial for pre-existing conditions, this wouldn't happen, but now I'm really scared.

I am definitely a candidate for surgery. 38 years old, 5'3", 275lbs I left there feeling like I was putting my whole financial future in jeopardy if I self-pay.

[iloveorganicmilk1 10]

maybe going to mexico is an option?

[micro_me 7]

I can afford the surgery at the hospital here. I don't think Mexico will keep me from having complications or save me the out of pocket costs of complications. Though it would be cheaper and leave me with more of a buffer...

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[Joy@boman 151]

I think its good she was honest about the whole thing but remember they love insurance. They can charge it out the ying yang. But there is a valid point about complications

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[Inner Surfer Girl 12,015]

My surgeon requires Bliss insurance for self-pay folks. Personally, it looks like a great program.

[micro_me 7]

So I could buy bliss insurance?? I will look that up!

She said they don't offer it, so I thought I had to buy it through the hospital.

[micro_me 7]

From what I gathered, BLIS insurance requires that the surgeon be approved for their program. Perhaps I need to look at other programs that may have BLIS insurance as an option. It sounds like the first place I met with did, but I wasn't thrilled with other aspects of their program. There is another option that isn't too far away. I'll reach out to them and see what I can find out. Thanks!

[tenseintexas 182]

I was self pay and they didn't mention anything about any of this if you had a hernia later- could it be proven it was from that surgery??

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[Inner Surfer Girl 12,015]

So I could buy bliss insurance?? I will look that up!

She said they don't offer it, so I thought I had to buy it through the hospital.

It's actually offered via the surgeon's office. So, if they don't offer it I would definitely look more carefully at the surgeon.

[micro_me 7]

I was self pay and they didn't mention anything about any of this if you had a hernia later- could it be proven it was from that surgery??

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I think things like internal hernias and blockages that are known complications could potentially be denied by your insurance. That was the impression I got. I believe that those complications are less likely with the sleeve than the bypass, but could still happen.

ETA: The first hospital I spoke with said this would NOT be an issue because pre-existing conditions can no longer exclude you from getting treatment for current problems. The second hospital gave me a different answer and said the first hospital was mistaken.

Edited October 19, 2016 by micro_me

[micro_me 7]

So I could buy bliss insurance?? I will look that up!

She said they don't offer it, so I thought I had to buy it through the hospital.

It's actually offered via the surgeon's office. So, if they don't offer it I would definitely look more carefully at the surgeon.

I will continue to do research. The center is a center of excellence and the surgeon has done over 1000 procedures (more than 500 of which were sleeves--the rest mostly RNY). The hospital is part of the Cleveland Clinic. I thought I was choosing a really great program. Now I'm having concerns.

[saralm 13]

I know that all insurances are different but I knew a lady that was self pay and her insurance covered all her follow ups and the hernia surgery later

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