self-pay & complications

jayme · March 13, 2008

I am not yet banded, and will be a self-pay. Obviously I have to get exact details from my insurance, but has anyone had complications after a self-pay surgery? Will insurance cover infections, flipped ports, and other problems associated with banding?

:smile2:

Banded091307 · March 13, 2008

Hi Jayme,

You will want to check with your insurance company to see if they will cover complications after surgery. Some things to consider are that your surgeon may order testing after surgery if you do have complications, for example xrays with fluoro, an upper GI, or a Scan with contrast. (Keep in mind some of these test may be ran even if there isn't a complication, but more of a precaution.) All of these procedures can be pretty costly out of pocket. Most hospitals will give you a discount if you are paying up front with cash and ask for a discount. Also, talk to your surgeon. See if there are any "warranties" with their work. If you have a problem right away, will they cover it, etc.

Good Luck!

cashley · March 14, 2008

I've had the band since 2/8/06... I lost about 55 pounds but then something happened and I started getting horrible acid reflux.... so bad I have a hard time getting any sleep some nights. He removed the Fluid from my band and it's slightly better but still bad.

I'm disappointed in the band as it's not working any longer for me and I was self paid @ $17,900 / which isn't chump change. The good thing is my doctor is turning all the "acid reflux" testing into insurance so I don't have to pay much extra for now.

I had great restriction and loved the band for about 8 months - he said there isn't any slip or problems he can see on the x-ray but I still have the severe acid. I can't have any Fluid in my band so I don't have any restriction thus gaining 20 pounds.

It's scary and disappointing and I don't have any advice. I just wish my band was still working for me.

SherriWittler · March 15, 2008

I was self pay and my insurance will not pay for ANYTHING at all .... I had a bunch of trouble just this month w/ my band and I have had to pay right at $1,100 out of pocket.

katwest · March 16, 2008

I was self pay and boy did I have complications. After surgery I developed double pneumonia and severe anemia. I had to be hospitalized for a week. My insurance paid. then, being stupid i got a peice of meat stuck and insurance paid for that too. Now band complications, ie leaking etc, I have no clue about.

Maddog · March 16, 2008

I was self pay 7/2/07. After my second fill, I had horrible problems with acid reflux, couldn't eat anything or sleep. I had to get an upper GI - my insurance paid. It seems that my band has slipped. I've lost 55 pounds in total. After determining that my band had slipped, my doctor reduced my fill to 1 cc. Since then, I haven't gained or lost (approximately 1 month ago). My surgeon has recommended going back in and trying to tack the band back up again or possibly replacing it with the newer design band. He won't know until he gets in there which one he will have to do. It depends on whether it has floated up or is wedged low. And, of course I'll have to self pay for the second surgery. My surgeon will not charge for any additional surgery within one year. However, I will have to pay for the hospital and anesthesiology. If they re-tack the original, it will be slightly less than $5k. If they have to put in the new one, it will be approximately $11k. I'm trying to decide what to do. I'm only 30 pounds from my goal weight.

jayme · March 17, 2008

Wow, after less than a year it will still cost that much? What band do you have now, and how common is slipping?

Maddog · March 17, 2008

I have INAMED band. My doctor says the newer design band is much less prone to slipping.

christiana · March 18, 2008

Hi, I am a self-pay bandster. I had my surgery in Mexico and about a month after I developed a blood clot in my leg (doc said from surgery/flying). My insurance covered all the problems due to my blood clot. However, I ended up losing my job because of missing work because of the clot and now I'm in way deep trying to pay off my surgery! I think insurance will cover any issues that aren't directly related to the band (slippage, erosion, etc).

laurieu · March 18, 2008

I was selfpay, two weeks after surgery found out I had staph infection my insurance has covered everything regarding the complications. I kept expecting them to call me and tell me they made a mistake but they even had a case manager follow my progress with all the problems I had. I was very honest with them about the surgery. My short term disability from work kicked in as well because I was off for 7 wks.

newday6 · March 19, 2008

I had my band last January, and was self-pay. Luckily, I haven't had any complications, because my insurance company has a specific exclusion for non-covered services. The language they use is "will not pay for non-covered services or complications that are a related to non-covered services".

I work for them, and I know for a fact that they would request money back if they 'accidentally' paid for anything related to my surgery.

Let's hope for the best, though....maybe you won't have any problems to worry about. And, if you have enough weight to lose, isn't the risk worth it? It was to me, and so far I've lost almost 90 pounds. :biggrin:

kpiekkola · March 19, 2008

I've got some type of infection and I am scared to see my own doctor.

She actually had it done herself in Mexico three years ago.

I was selfpay, two weeks after surgery found out I had staph infection my insurance has covered everything regarding the complications. I kept expecting them to call me and tell me they made a mistake but they even had a case manager follow my progress with all the problems I had. I was very honest with them about the surgery. My short term disability from work kicked in as well because I was off for 7 wks.

kpiekkola · March 19, 2008

I've got some type of infection and I am scared to see my own doctor.

She actually had it done herself in Mexico three years ago.

I was selfpay, two weeks after surgery found out I had staph infection my insurance has covered everything regarding the complications. I kept expecting them to call me and tell me they made a mistake but they even had a case manager follow my progress with all the problems I had. I was very honest with them about the surgery. My short term disability from work kicked in as well because I was off for 7 wks.

kpiekkola · March 19, 2008

I've got some type of infection and I am scared to see my own doctor.

She actually had it done herself in Mexico three years ago.

I was selfpay, two weeks after surgery found out I had staph infection my insurance has covered everything regarding the complications. I kept expecting them to call me and tell me they made a mistake but they even had a case manager follow my progress with all the problems I had. I was very honest with them about the surgery. My short term disability from work kicked in as well because I was off for 7 wks.