Self Pay Patients

[motherwanttobe 0]

Be sure to do your research. I had my surgery 4/07. I am lucky my insurance did pay for the procedure as well as for the follow up. I tolerated the procedure well and have had no problems to date. I am down 68 pounds and am very happy; but I have heard and read many horror stories from self pay individuals.

Examples:

1) Self pay patient had internal adhesions from other non related procedures. During the procedure they discover the adhesions. They had to remove the adhesions. This required additional medical care and follow up. The insurance company, which did not cover the procedure or related costs, stated everything stemed from the intial non approved procedure. That nearly doubled her cost.

2) Self pay patient developed pneumonia, insurance refused any costs associated with the pneumonia because it was associated with the non approved surgery.

3) Self pay patient developed stomach and esophagus ulcers, 1 year post. This required testing and draining the band 2 years post the procedure. Since her issues were the result of the banding the insurance company refused to cover any of the additional expenses stating it was all related to the initally unapproved procedure.

4) Number of follow up visits and fills. When you are self pay, many times you can negotiate your fills for the first year to be included in the cost of the procedure. If not what can you anticipate: each visit an estimated $100 and the fill another $150. How many fills have I had in 1 year? I had my first fill 6 weeks post the fill. I have had additional fills every 10-12 weeks. Then at the 1 year point you have bloodwork and an upper GI to ensure you do have not developed ulcers. I am told I will require the same bloodwork and upper GI at the 2 year point. I don't know about after that. After year 1 the fills will greatly decrease. After 2 years the fills are about every 6 months, just to tighten it up a little and make sure you are slipping back into old habits. Every person is different this is just my experience and what I have been told.

I am not discouraging anyone from having the procedure. I am simply stating you need to be aware.

[VegasGrace 1]

Not sure about number 2 as my pneumonia was covered.

Losing weight can cause issues such as low potassium, flu/pneumonia, gall bladder issues, etc. This goes even without the band.

Self payers also are some of the most efficient patients...ensure they stretch their dollar. They ensure their doctor follow the recommended procedures for adjustments.

I got 2 fills, right on schedule, for the appropriate amount. And that carried me thru my weightloss. Others have posted how their doc doesn't follow the guidelines, play cat and mouse with fills and have to go back more times to get the amount they should have gotten like self payers.

But boy, how nice it would have been for someone else to pay this!

[kristylyn 0]

Well I am an selp payer and All those things that was listed NEVER HAPPEN TO ME..I am doing great, never got sick, all my holes are healed perfectly. I have the same fills just like insuance patients. My Dr treated me faily just like if my insrance paid for it. The only thing differently is that my Dr got his money that day from me and he didn't have to wait for the insurance company to send him the money. I don't know how told you that everything like that is suppose to happen or not, but I think it depends on the dr who is doing you. Nothing ever happen to me. The only thing I do get is one free year andyes I do have to pay after that is up for my fills but if I get sick, then I just go to my regular Dr where my insurance pays just like going to a regular Dr. I understand that everyone is different, but I am just letting you know that nothing like that has happen to me that you listed .

[Jaymie72 0]

WOW!! Where are you getting your information? I am sorry but I find all that very hard to believe. Are you telling me that just because I am self pay that I am going to have more risks than insurance paid patients?? I have serious doubts about that. Or are you saying that your insurance will not pay for any complications due to the lap band?? I think when you are self pay, like I was, you look at your options and weigh them carefully, I know I did. I guess I just think your post is a little negative and that is not what lap banders need, negativity. If ever I have complications I am sure the Dr. would work with me. Seriously, what is the difference with giving he Dr a payment vs an insurance payment? (I do have insurance BTW)

[nip50 2]

I'm self pay and couldn't be happier. In fact, the doctor found 3 hernias when he did the band and repaired them at the same time at no additional costs and my insurance paid for the follow-up care on the hernias. As far as fills are concerned, everyone's situation is different. In fact, I have up to 5 free fills/unfills per year, forever, whether you have insurance or not.I would recommend this to anyone who needed it.

[Elisabethsew 50]

EVERY patient, regardless of ability to pay or not, MUST receive the same care by law.

[TracyinKS 7]

Insurance pays exactly what YOUR EMPLOYER tells them to pay. Period. Exclusions all stem what the employer tells them to exclude and when. Some docs can work around this by coding things properly.. (i.e. hernia fixed while in there)

Every person reacts differently to the band.... I think the original poster merely wanted to point out what COULD HAPPEN.. not that it's going to happen......

EDUCATION IS KEY! Do your research.

[anewbb 0]

I am going to be self pay and I am worried about the cost of any complications I may have. I found information about a program called BLIS.

www.bliscompany.com

It is a type of insurance that covers the surgeons they contract with. You pay a little more up front, but they will pay the doctors and hospital if you have complications. I am still researching them but I found the information on OH.

For me it is important to be prepared "Just in Case"

Edited May 2, 2008 by anewbb

[Great2BThin 5]

I will be a self pay patient and am in the prescreening process now. I find the original post to be rather condensending to those that have to self pay. More like a have vs the have nots. An insured person can have complications just as easy as a self pay. All insurance varies as to what they'll pay for. Since the OP wasn't self pay, I am unsure of the motive of posting all that was for. I am going to give it the benefit of the doubt and believe that it was for education. But seriously, don't you think if I am going to shell out thousands of $$$$ I am not going to do the research? I am going to a dr. in Denver that is more expensive than a few others (there is one here that people fly to from all over the US and another one that only charge $9900). I am purposely going to one that I feel comfortable with his experience, his follow up care if complications, etc. In fact this dr. has had one of the other 2 docs refer people to him. Also as another poster mentioned the dr. can't discriminate in the quality of care you receive whether or not you have insurance coverage. It's not only self pays that have complications. The thought of possibly having one scares me to death, but the thought of remaining morbidly obese scares me even more. I believe the reward outweighs the risk.

[MacMadame 81]

I guess I just think your post is a little negative and that is not what lap banders need, negativity

What we need is the truth. The truth is that if you have complications after your band is placed -- and some people do -- that there is a risk that your insurance company will not pay for them. This has happened to self-payers before and it will happen again. To pretend that it does not simply for the sake of "being positive" is wrong IMO.

As for your doctor working with you, some do and some don't. If you have your band put in and have direct complications from the band immediately afterwards, your insurance will not pay for it. There have been self-payers who had to have their band taken out within weeks or months of it being put in and they ended up paying for that too. So they paid twice what they had planned on and ended up with no band.

If you have complications that can be indirectly attributed to the band, then some insurance companies will use the band as an excuse not to pay for them as well. Others will not and will treat you fairly. But the risk is always there and it's something you have to be prepared to deal with if you self-pay.

Sometimes it depends on the doctors office. Some offices are really savvy about the insurance codes and will really work the insurance to get as much paid for as possible and others just do what they do and, if insurance doesn't cover it, too bad.

I've been lucky so far... I've had all my pre-op tests paid for by insurance even though the band isn't covered. But I make sure the people I deal with know how to work the system and I work the system as well. For example, my psych consult was covered under our EAP plan and not our medical plan. The EAP plan is generous and doesn't care what your psych consult is for. For my nutritional appointment, the dietician coded it as being about my hypertension and not about getting a band. My original surgeon codes fills as office visits. Office visits are covered. :thumbup:

I have seen people who could barely afford the band taking out loans to self-pay and then not been able to afford follow-up care or having disaster strike and have to take the band out and have to come up with the thousands to pay for that. That's a really horrible place to be in and it's why I'm waiting until I can change insurance to actually get the band. OTOH, if I can't get insurance to cover it, I will self-pay. But I'm prepared for the additional costs. I haven't got my head in the sand about them.

[VegasGrace 1]

I hope what you are meaning to say is:

There are risks with the Lap Band. Know them before doing this. [ Hope for the best but prepare for the worst. Have a backup plan in place if a complication does arrise ]

If you are willing to take the risks.... good for you for taking control of your life.

If you can find someone to pay this procedure for you- great! (ie-insurance) but if not, hate it for you but if you still go ahead with it....you are brave for trying to change your life for the better.

And if you do have someone else to pay for it, ie-insurance, just know that although there are hoops of fire to jump thru, it's an umbrella and can help save money.

The care is no different if it's paper or plastic.

The risks are no different if it's paper or plastic.

Congrats to all those who take the risks and it pays off. For those of you who it doesn't.... you are still a better person for having tried to alter your life.

[mary1966 3]

Have you heard of Bliss insurance? It is an insurance policy that covers anything that might happen as a result of the band during surgery to one year post-op and costs about $900.00. I am paying the extra for piece of mind.

[VegasGrace 1]

Hey, thats a neat product...lapband insurance.

[greeneyedlady19 0]

my daughter was banded in feb 08 and 1st fill in march 08. all has went well with no downfalls. and by the way, i paid cash for her procedure. as one other said you need to also think about the problems associated with being obese. stroke, heartattack, diabetes and all that goes with diabetes. i believe obviously because I paid for this to be done to my daughter whom i love more than my own life. so that right there should say something. it was worth every penny i have put out to see my daughter already lose 30 pounds. she's doing great and is already feeling so much better about herself and even out walking and exercising. by the way, dr.aceves did her band.

[Kat817 19]

I was self pay, although my insurance covered lap banding, there were at the time some long lasting hoops to jump through. I tried, and 10 1/2 months into the 12 month medically supervised diet, I was in an accident, and they were going to make me start over, it had to be consecutive months---so I opted to self pay in Mexico.

Recently I got sick, and was thinking I might have to unfill, I got very tight, due to nausea, and high fever with the virus I had. I called my insurance, and found I am covered with anything pertaining to my band, I just have to have an in network Dr. Well there are none in my area----in or out of network----so it will cost me a flat 20%----and my share could be as high as $7500.00 as opposed to the max out of pocket with an in network of $2500.00. But it is covered....and I had no idea! Same goes for my fills!

But I have only had 2----the last one being 22 months ago! I am having a total unfill for my TT later this month, then will begin filling again---but it is good to know insurance will help! Insurance is also covering my TT.

It did not change much my being self pay.....except my account balance!!!

Problems can happen yes. We should ALL research thoroughly before making the choice to be banded. However, people change jobs, and with it insurance, many of us might find our circumstances changing. There is another post that could be made, with a long list of possiblities too.

Remaining Obese increases health risks:

The list of examples here could go on, and on, and on!

Scare tactics are non productive----citing examples without us being able to read the story and judge the releativity to our own situation makes it difficult.

While the situations you mention, are definitely possibilities---having some solid stats would help us to weigh the odds.

Kat