Self pay what happens if complication

[sunshinegal22 8]

I don't currently have insurance but I'm planning to do the sleeve self-pay. I began looking for insurance companies just to add an insurance policy in case there's some major complication after words that isn't covered in the self-pay option. What I have found is that no insurance companies will not cover complications related to bariatric surgery that they have not paid for. My question is for those of you who have done self pay options what did you do about the potential complications and protect yourself should you have to end up in the hospital afterwards losing everything you want to pay the bill? I know complications or rather minimal and I've already had my gallbladder out, but I just am worried about what happens or what other people of done to protect themselves.

[Berry78 4,261]

Well, my FIL needed emergency open heart surgery 16 years ago. He had no insurance. Racked up an ungodly bill.. he was hospitalized for over a month on top of the surgery.

They are still paying the hospital (or collection agency) every month. It's just another bill.

I have health insurance, but if it wouldnt cover a problem, I'd get treatment and worry about the cost later. (Wing and a prayer).

Dr. Illan did say that if I wanted to go back to him for treatment that that would be a possibility. Of course distance means it couldn't be a life or death situation.

[JT2002TJ 170]

If there is a complication, and if it is due to a medical error, tell them you will not pay for any added costs due to this error. You do not have to pay for medical errors (although they will try to bill you for it). I work in healthcare, insurance companies do not pay for these errors, so neither should you...

If it is a complication NOT because of a medical error, then you will be on the hook for it.

[forgetmenot 27]

I was self-pay as well and I am extremely risk-averse. By the time surgery day rolled around I still wasn't completely assured but here are some steps/considerations I took:

There is a program called BLIS specifically targeted to self-pay WLS patients to insure against complications, you can google search the company easily. The wrinkle is that you have to purchase through the surgeon directly (and obviously they only offer the insurance to surgeons with low complication rates). If you are still flexible on who to do the surgery with, then you might want to look for a BLIS-enrolled one. In my case, my surgeon tried really hard to come to an agreement with BLIS but he couldn't cut through the red tape.

My surgeon told me that the only kind of complication that could bankrupt me were blood clots, which could lead to strokes, etc if they went untreated. Anti-clot medications (and compression sleeves) are a standard part of your post-op dosages but I nagged the doctors to give me the maximum dosage possible. After discharge, I fought through the pain and nausea to move around as much as possible to clear any clots. Again, this is a standard recommendation but the possibility of having to pay for complications out of pocket gave me an extra source of motivation.

After my amateur legal sleuthing through my insurance policy documents and other legal documents, I came to the conclusion that your regular insurance has to pay for emergency care even if it's a WLS complication. For example, if you had a leak or blood clot, the cost of stabilizing you in the ER should be picked up by your regular insurance. If the surgeon needed to go back and stitch up a leak or if you had severe GERD that required conversion to bypass, then the costs would be self-pay. However, I figured that, unless the problem was extreme, there should be an usually a less expensive way to address the complication which required more self discipline. The caveat here is that I'm not a lawyer, so please don't interpret this as formal legal advice.

In my case, I did have a very minor post-op complication with swelling and Water retention. I decided to go to the urgent care clinic instead of the surgeon. I made a judgement call between the surgeon's expertise and the potential costs I would incur for something I didn't think was life-threatening. I predicted that the over worked urgent care clinic is not going to spend the time to formally make a determination on whether my complication was a result of WLS and they have very little incentive to specifically contact the insurance company to connect the dots between the two. Again, I have no inside information on how insurance companies flag charges for complications from non-covered procedures (I wish I did), this was purely conjecture. In the end, my urgent care visit and treatment was paid by insurance just like any other urgent care visit/treatment.

Hope this helps and good luck with your surgery.

[JKC2016 82]

I was self pay and they had to go in again--I had some internal bleeding. I paid for the extra surgery and the blood transfusion. If i had purchased their insurance i wouldn't have had to cover those costs. It wasn't too expensive. And all my follow up care has been through my regular medical provider and insurance.

[GassyGurl 428]

Blue Cross federal will not deny complications. It doesn't matter where the surgery was done, or how it was paid for, they will treat it like any other claim. At least that's what they told me via a secure message.

If you're thinking of traveling for surgery, you can get post op insurance. I think it's based on a time frame and dollar amount. For example, 300k for 30 days might be $500.

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