self-payer questions

[fillerup 0]

I have been lurking for quite some time and saw my surgeon today. I will be self-paying since I have Kaiser and my BMI is not high enough. I do have hypertension and am pre-diabetic. Both were learned recently. I understand having to pay for the surgery etc... but what I really would like to know is has anyone else had to pay for the stuff required before the surgery, or did Kaiser cover it?

My surgeon requires blood lab work, 12 lead EKG, psyche eval, physical for General Anesthesia clearance and chest xrays prior to surgery. Did Kaiser cover these expenses for anyone? I called and spoke with an advice nurse and will not hear back until Tuesday.

[Emilie1 3]

They should cover the test, but check first if they don't cover them ask your PCP to order the same test. If you have comorbidities and a BMI between 35 - 40 your insurance may cover the surgery. Maybe even a little lower BMI. You should submit your paper work for insurance anyway. It can't hurt to try. Good luck.

[jmegirl 2]

Yikes! My insurance required an 18-month supervised diet (among other things) so I decided to go the self-pay route. At first I was going to head to MX for surgery, but my husband convinced me to spend a few extra grand and stay in the US. I'm being banded by Dr. Kirshenbaum in Denver, CO and he doesn't require anything before surgery except a short pre-op diet to shrink the liver.

I was under the impression that all those pre-op tests were required only if you were going through insurance. I thought it was the insurance companies that required the tests! I think it's crazy that the surgeon is requiring the tests. If you ask me, I think you're spending enough money paying for the surgery yourself, and that you shouldn't be required to pay out-of-pocket for all those other tests you mention. Don't take my word for it, but I'm pretty certain that if you aren't heavy enough to qualify insurance-wise for the surgery, then chances are they won't cover the pre-op tests that are required either. And if that's the case, I strongly suggest you find another surgeon. I don't think many surgeons out there require those kinds of pre-op tests. Besides, you said yourself that you're not heavy enough to qualify for insurance, so chances are you don't need all those extra tests for health reasons.

Good luck!

Also, if you're interested at all in traveling for surgery (I'm traveling from NC to CO for mine) you can contact Dr. Kirshenbaum. www.lapbandrockies.com He charges a flat rate $9950 for surgery. My total, including flights for 2, hotel and rental car, comes to just under $12000. And Dr. K doesn't require any pre-op testing.

[fillerup 0]

I also contacted Dr Kirshenbaum, but could not find any fill centers near my home. I think with the follow-up appointments to Denver requiring airfair, hotels and car rentals , it would end up costing me about the same amount. The scary part for me would be the time and distance from my surgeon should something go wrong. I sure hope my insurance carrier foots the testing bill. Good luck in Colorado. Let us know how it works out.

[ForMyBoys 0]

doctors ask for all those pre-op tests because it's important for him and for you to know that you are healthy enough to have surgery done. We are already at risk by being overweight. My doctor required all the same tests and results all came back fine. I would rather find out beforehand if there were to be any complications then while I was on the operating table. Im glad my doctor went the extra mile to care for me. My sister and brother in-law are both anesthesiologist and said that a patient should always have at least a chest x-ray, ekg, and blood test before being put under anesthesia. Follow your doctors orders and get the tests. You'll feel much better knowing everything is in order before you "go under". Good Luck

[jmegirl 2]

I also contacted Dr Kirshenbaum, but could not find any fill centers near my home. I think with the follow-up appointments to Denver requiring airfair, hotels and car rentals , it would end up costing me about the same amount. The scary part for me would be the time and distance from my surgeon should something go wrong. I sure hope my insurance carrier foots the testing bill. Good luck in Colorado. Let us know how it works out.

I completely understand not wanting to travel back and forth for aftercare. I'm happy that, with Dr. K, fills are free for the first 3 mos (and $15/fills thereafter) but the cost of a roundtrip flight is in the neighborhood of $200-250 for me. Not to mention it's an entire day's trip to fly out there and back, which means one full day out of work (but I can take sick time for doctor's appts so I'm good there). The cost at Fill Centers USA was a $375 start-up fee (which just gets you in the door) and then $250/fill, not to mention a 3hr one-way car ride. I think they even charge if you need an unfill!

So ultimately, I don't think I'm spending much more by flying back to Denver for my fills, although I'm using a little more of my time then I'd like. It's important to me to have my surgeon doing my fills, as opposed to a doctor I don't know who knows nothing about me or my band. I'd love it if my surgeon were local...but when you're self-pay and don't have a lot of expendable cash, I guess you take what you get! At least I'm not going to Mexico.... :rolleyes2:

Good luck to you! Let us know what your insurance company says. I hope for your wallet's sake that they pay for the tests!

[fillerup 0]

Formyboys,

I don't mind having to get all the tests. I agree it's a good thing and they need to know all they can before they operate. I think Dr Kirshenbaum does all the tests during the 3 day visit to his center. My problem for now is who pays for them and if not my HMO, then where do I go to get them done and how much can I expect to pay? My surgeon has not provided me with any suggestions, only his required tests for surgery clearance. The rest seems to be up to me to research and get done. Some definate hurdles.

[jms462001 9]

I also have an HMO and they will pay for nothing with WLS being listed as the reason for the test. I also have a Dr. who is ordering every test under the sun. Even my primary is a bit surprised. I think they want to maintain their record of 0 fatalities in surgery. And, it is really good to have some of those heart and lung tests. I did read about one woman who discovered a heart problem that would have been deadly had she only had an EKG and not been required to see the cardiologist and go through a rigorous series of tests. Now, this does not make me feel much better as it is probably costing me about a thousand extra!! He is not, however, making me repeat tests I had in the past year such as an abdominal ultrasound and pap. I do even have to get my mammogram which I let go over by 2 months. My insurance had better cover that!! I thought they should cover the blood work since that is supposed to be done routinely every year or so anyway, but they won't because a lot of additional out of the ordinary things are being tested due to the surgery. By the way, I have Healthnet HMO!!