How Does Anyone Know What To Do??

[Taylor5 98]

I thought once I got my loan to self pay for VGS that everything would just fall into place. Wrong. To begin with, my loan approval amount was just shy of my quoted cost at the nearby facility where I want to go - Reading Weight Center/Tower Health/Dr. Leon Katz. Also, the interest rate - insane. But nobody else was turning cartwheels to provide a loan, so I sucked it up and figured the end result would be worth it.

Send several messages to surgeon's office to let them know definitely self-pay since my insurance excludes the surgery. Takes them forever to get back to me each time I reach out. They remind me my insurance will Not cover any complications related to this surgery either during/after or down the line. Just seems wrong since my premiums are more than my mortgage, but that's a different rant. So I ask if they offer complication insurance? She doesn't think so... Is there any wiggle room in the hospital's fee (the largest part of the bill)? She doesn't know but gives me the # for billing to ask them. I call billing & they can't help me unless I have a question about a bill for services I've already received??

Meanwhile, I have reached out to several facilities near and far for comparison. Most have lower fees for the entire procedure and some say they offer complication insurance. Most places haven't gotten back to me after 24-48 hours {doesn't install confidence about their response post-op when you have returned home & have questions}. The couple that have, I asked the one in FL if I have a complication, do I have to return to FL for help? What if it is emergent - as I am in PA? She does not know, she will ask and get back to me, but still hasn't.

So discouraged. Bad enough to pay a fortune for crappy insurance that won't cover the surgery (yes, already looking to switch for open enrollment, but we are self employed, and No plans in our area cover the surgery for our type of plan). Then actually get a loan (but feel sick about monthly pmt) - still can't get excited because no one seems to want to answer questions or help me get moving with this!! I never would have worried about "what-ifs" for complications since I've several types of surgery w/o any, but they make a point of bringing it up, so I have to worry now. How does anyone Ever know What to do? -sorry so long-

[Sosewsue61 3,185]

Oh wow. Complicated mess. I wish you luck, but have no experience to offer you in negotiating your specific issues.

[Starsmore 60]

If you are paying up front, they may offer you a discount in the total amount due. I know that when I paid my bill in full after my thyroidectomy at the hospital I'll be having my sleeve done at, they gave me a discount (granted, it didn't really work out as well as I hoped because I put it on a credit card...). I would ask about that. It'll at least be a little bit and may bring that price closer to the financial window you're working in.

I have no advice to offer about complication insurance, but I hope you can find something that works for you.

[Taylor5 98]

33 minutes ago, Sosewsue61 said:

Oh wow. Complicated mess. I wish you luck, but have no experience to offer you in negotiating your specific issues.

I know, I know, Thank you for listening!!

[Taylor5 98]

8 minutes ago, Starsmore said:

If you are paying up front, they may offer you a discount in the total amount due. I know that when I paid my bill in full after my thyroidectomy at the hospital I'll be having my sleeve done at, they gave me a discount (granted, it didn't really work out as well as I hoped because I put it on a credit card...). I would ask about that. It'll at least be a little bit and may bring that price closer to the financial window you're working in.

I have no advice to offer about complication insurance, but I hope you can find something that works for you.

Thank you : ) My thinking is similar, although they require all fees paid before they will schedule the surgery, so offering to do so is kind of a moot point. But I am still trying to negotiate it based on the fact that they promote their self pay prices as being fair due to being half of what they charge Ins Cos. However, I used to do medical billing and I know Ins Cos only pay half or usually less of the amount they are billed, so I feel that should be taken into consideration at least. Taking off even a couple thousand would leave a little cushion in case of complications. I brought that up w/the bariatric lead and that's when she transferred me to Pt Access, which turns out to be hospital billing...who said they can't help unless I already have a bill, lol.

[jhope71 105]

Mine reduced the self-pay fee because I was also having a hiatal hernia repaired, which was covered by insurance. I had to pay up front, and he was able to bill it and get it covered as one operation, so it seems I didn't need to pay all that anyway. I'm currently waiting on more than $5K in a refund from the hospital. Surgery was in April, and I'm getting the run-around. The whole insurance industry is a mess!

Also, while you're calling around, ask about supplemental BLIS insurance. My surgeon offered that for self-pay patients, and it covers a year of followup visits and any possible complications. Well worth the money. I think it was around $2500. Sounds like a lot, but worth the peace of mind.

[Taylor5 98]

12 minutes ago, jhope71 said:

Mine reduced the self-pay fee because I was also having a hiatal hernia repaired, which was covered by insurance. I had to pay up front, and he was able to bill it and get it covered as one operation, so it seems I didn't need to pay all that anyway. I'm currently waiting on more than $5K in a refund from the hospital. Surgery was in April, and I'm getting the run-around. The whole insurance industry is a mess!

Also, while you're calling around, ask about supplemental BLIS insurance. My surgeon offered that for self-pay patients, and it covers a year of followup visits and any possible complications. Well worth the money. I think it was around $2500. Sounds like a lot, but worth the peace of mind.

That's awesome they combined your surgeries, but definitely a headache waiting on reimbursement! Yes, BLIS is what I have been asking about! I can't find anyone local to me who offers it. It's definitely worth the cost for what it offers, but not as helpful if I have to drive or fly several states away to return to the surgeon for follow-ups or complications. My local surgeon won't see other docs' patients until they are at least 3 months post-op and out of the immediate danger zone. I mean, I don't blame him, but if he offered BLIS I wouldn't need to look anywhere else!

[Berry78 4,261]

Have you considered Mexico? I went with Dr. Illan, and had a good experience. You probably have the same chances of complications wherever you go, but if Mexico is cheaper then you have that buffer. (I live in Maryland).

[Apple1 2,572]

I also had surgery in Mexico with Dr. Illan and I had a very good experience. I would definitely consider this option.

[Kat410 423]

This is exactly why I chose the Mexico route.

I was also self-pay and truthfully I wanted to be able to bring my cashier's check for a quoted amount and be done with the hassle.

I coordinated with my PCP and did all the pre-op tests (most of which are covered in an annual check up, which I was due for anyway). I sent the records to the doc in Mexico (they still did their pre-op tests, which was fine). My PCP was aligned with the choice and I knew financially it could backfire if I was one of the rare people who had a complication. I prayed that the stats stayed on my side and they did. For co-morbidities I was pre-diabetic and borderline hypertensive.

The experience in Mexico was great - albeit different from the American healthcare system.

No complications, no problems and I was fully informed and educated of what could bite me in the a$$.

I paid about 5K for my surgery - all expenses except airfare and the upgrade from the mediocre hotel in Cancun.

I would research it for yourself if you haven't already and if you think it's an option for you, consider it!

[Lovergurl 59]

I used OCC in Mexico. The process was flawless from the time I stepped off the plane till the time they took me back to airport. Very nice hospital and hotel. Excellent care. Just a really good experience. And Dr. Ortiz is accredited just like US hospitals. I was back on a plane 4 days later.

Edited October 20, 2017 by Lovergurl

[Taylor5 98]

@Berry78, @Apple1, @Lovergurl and @Kat410,

Thank you all for your responses and feedback on your successes in MX. I have considered it because I know others have had good results, but it was kind of a last resort idea for me - for one because I have a lot of back issues/chronic pain and don't know how well I would do on the flight there. To be honest, Florida is pushing it between the airport and the flight, but I was also supposed to be doing an intrathecal pain pump trial soon and thought that might help me survive the flight if I end up having it implanted. Now my pain doc isn't getting back to me to schedule that (really not my month for success w/drs I guess).

I finally decided today to say scr^w the consequences and book w/my local hospital to have access to the support group and follow up care. Turns out the woman I've been assigned to recently fractured her foot, and then had a death in the family. So that is partial cause for no return calls. They let me schedule a nurse phone health history next Friday 10/27, then a surgical consult with an internist there on the 31st, but said they can't schedule my nut appts til after that and she has no openings til Dec as of now.

They are still making me do 3 nut visits, even though self pay, prob a month apart, and even though my ins is supposed to cover that they said they checked and they don't and cash price is $800 for 3 visits!! Also, since so many ppl need appts, they are thinking of doing "group nutrition" classes, so if they do, maybe I can come in sooner than Dec - maybe. I'm thinking - why would I pay $800 for 3 nut visits to begin with, much less 3 Group nut visits? It just seems like a lot of money to me, and on top of the self pay price.

She also said "Kay", who is "my person" there, will be in a couple days next week, and she needs to check with the hospital about pricing because they don't know how much anesthesia fees are or the hospital fee - But all 3 fees are broken down in the info packet I got from Kay at the seminar! Surgeon/Anesthesiologist/Hospital. And, she said they are going to set everything up and bill to my ins co anyway, as if they were going to pay, even though we know they won't because it's flat out excluded. I have no idea why. One of the only perks of being self pay is supposed to be a few less hoops to jump through. Now I feel as though they are purposely creating more or acting unsure of pricing all of a sudden!

Maybe they don't want my money?? Honestly, maybe they just don't get that many self pay patients and they don't want to deal with the hassle so they are trying to wear me down. Well it's working, because I feel like just giving the loan back and calling it a day. As a long time chronic pain patient I am used to having to constantly advocate for myself, but sometimes it just gets to be too much. I'm sorry to include you in my pity party - I know it is pathetic. I didn't even question anything she said on the phone because my mind was spinning thinking, "This doesn't make any sense!" Now I'm thinking of everything I should have been saying, of course!

I don't know, I guess I'm going to sleep on it. I will probably look into Mexico more - maybe I will end up going there...But I can't see any of my current doctors being helpful with that. They will probably say I'm making a mistake, so getting help from them may be hard. Thanks so much for listening though. I just don't know who else to talk to. No one in my circle really needs to lose weight, much less go to this extreme. They just won't get it. It's a really lonely place to be sometimes...

[Berry78 4,261]

It IS really important to have follow-up care, routinely, after surgery. This is handled by a bariatric program if you live close enough. If you go a distance to get surgery or move away, your primary care doc can do it. Some family docs don't like taking on bariatric patients, so you'll want to have the discussion with yours to see how he/she feels.

My primary doc likes referring patients for bariatrics. She was nervous about Mexico, but did everything she could to help, not hinder. I should mention she is my NEW primary doc. My last one was going to do everything she could to stop me. Bye bye doc!

If you want to think about Mexico, I highly recommend getting a nonstop flight to San Diego the day before your surgery is scheduled. It is about a 6 hour flight from BWI, I don't know where you'd be flying out of (PA is a big state!).

You would need a passport, and that takes several weeks to come in (about 6 if you don't put a rush on it). That is the first thing to do if you decide to go that route.

There are no hoops by going to Mexico. But, it also means you have to educate yourself. You'll receive a diet plan to follow, but everything else is pretty much up to you.

I attend my local bariatric support group meetings and get my Vitamin panels through my primary physician. I have a GI doctor that I can see if problems pop up down the road.

During the initial healing period, if I had a bariatric-related emergency, I knew where my closest hospital that had a bariatric program was located. (An hour away). (Obviously if it were life/death, go to the nearest ER.)

If you went to Florida or Michigan, you'd need all these things to be in place too.. not just Mexico.

I live in Cumberland, MD. Don't know how close I am to you, but just know you aren't alone...

[Apple203 1,314]

Taylor5, I hope you chose to stick with it. I agree that its a pretty exhaustive (and exhausting) pre-op checklist we go through. On the positive side, we have a good understanding of our baseline health going into surgery.

Edited October 21, 2017 by Apple203

[GassyGurl 428]

I don't recall seeing what your self pay cost is, but there are places you can go in the US for $9000-$12000. I paid $8999 in Ft Lauderdale at Bariatrix, FL. Dr wizman offers BLIS, but I used Dr Taggar. Blossom Bariatrics in Vegas seems good, and Dr Borland in Louisiana has gotten good reviews. Maybe one of these cities has a non stop flight?

The other question I wanted to ask, is did you ask your insurance about complications or did you take your surgeons word? I wouldn't trust them, be your own advocate and ask your insurance company directly. I asked mine, and they were very clear that they would treat complications just like any other claim. It didn't matter where I had surgery, whether it was in our out of network, if they paid, or if I paid, etc.

Good luck!

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