just curious

[aaamom 0]

Hi All

I am new to this site and just love everyone's input/suggestions and humor !!!

I was banded May 23 in Boston, MA, and so far so good (35 pounds to date)

Two things I have been wondering about:

1- why do so many people go out of the country for their bands? Are they not readily available???

2- why do so many people pay privately??? I thought obesity was a medical condition and therefore covered by insurance?

Am I just lucky or what???

Keep Smiling !

[fireman20 3]

just wanted to say hello:)

[mousecrazy 2]

I don't know as much about this as the others probably do, but basically, there are still quite a few insurance companies who do not pay for bariatric surgery...the company might, but the individual plan may have it as an exclusion. It seems to be changing, though. Which answers your other question, I think people go out of the country because it costs less...but I may be wrong on that. Please, if someone knows more, I will hold no offense if I'm corrected.

Congrats on your band! I'm one of the lucky ones who had no problem with my insurance...surgery a week from tomorrow, 7/22.

Cindy

[giveyouthemoon 4]

I did self pay because my health insurance would cover only gastric bypass. I think the band is still fairly new so it's taking time for insurance companies to step up. Bypass is fairly widely covered but the band is not.

[La_madam 20]

Many of us had insurance that would not cover the band and if they did some of us had no co - morbitities that go along with being obese. This is why many of us went to other countries, it is less expensive to self pay in another country.. I was told by my PCP I was a healthy obese person, if you could believe that! Now Iam a healthy overweight person. I had a BMI of 42 now it is 29 and still going lower

[justbeingme 1]

In my case, I have to go out of the country because the fact I am too young to have it done in America, and Dr. Ortiz has come highly reccomended to us. Also, obesity may be considered a health condition, but I am not 18 so they will not cover me.

[mousecrazy 2]

Justbeingme, thanks for adding your story. I had never considered the age restriction...just the cost. I am glad you added your situation to the mix. I wish you all the best...you must be excited! Cindy

[barbaraann 0]

While my insurance co did not cover this, my husband was willing to pay for me to have it done locally for the convenience. After researching MX, I went to our area hospital for evaluation and comparison (a major university hospital) and was not impressed. They had only done 40 procedures in 2 years and 4 failed (10%) and had to be removed. The Dr. who did the procedure did primarily bypass surgery yet he was the specialist. Fills were not done with Floro and were not done by a doctor. A nice nurse told me that she handled all fills and the average was 6-8 fills at $400 each. I researched Ortiz/Martinez who have now done over 2000 procedures and presented their results at multiple conferences so I made my decision purely on expertise. I wanted what I believed was the best for me. I was just banded and sitting around the pool the next day were fellow bandsters including 3 nurses and the wife of a US surgeon who all made their choice based on expertise.

Barbara

banded 7/5/05

Dr. Ortiz/Martinez

down 19 pounds already!

[mousecrazy 2]

Barbara, how great to be sitting around the pool with other "lapdancers" (what my husband fondly refers to us as!). I wouldn't be comfortable at all with the situation you described at your local hospital, and Mexico sounds great from all the posts I've read!

Cindy

[Parvathi 2]

Not in the US, but I'll add in my situation anyways LOL.

I'm in Australia - insurance covered the band, apart from $3000 surgeon and anesthesiologist fees. Medicare (not the same as in the US, its our socialized health care system here and everyone is on it) covers all of the fills.

In the US though, I think some of the earlier bandsters went to Mexico for it because it wasn't approved by the government yet.

Barbaraann, your story about Mexico sounds excellent! I'm sure that made it much more comfortable and you probably made a few life long friends

[Infaith 1]

Personally, my insurance would NEVER pay for anything to help with my weight to save my life. They would pay for anything associated with it (diabetes, sleep apnea, asthma, etc) which I think is so dumb. It would actually save them money to pay for the surgery rather than all the meds, doctor visits, appliances and such. I just don't get it.

[soonergirl 0]

OK - on the insurance subject - Insurance will only pay for this if YOUR COMPANY choses to cover this - NOT THE INSURANCE COMPANY. The insurance company does have a program in place to qualify applicant for this and find out if it fits their policies.

Individual insurance will NEVER cover this surgery - the reason why is that insurance is never a contract that requires that individual to keep paying - right, you don't pay your policy you no longer have insurance, so it is basically pay as you go. SO - it would not make any sense for an insurance to cover this - you pay your $500 premium for 6 months, get it paid for and then cancel your policy. (also why you can't get an individual policy to cover maternity)

Most insurance companies that have only small groups also do not cover this! Small companies generally change insurance carriers like I change my socks. (I won't go into all of the reasons why) So esentially, a small company could also do the same thing - incur a great deal of cost in one year with that carrier and then move the next year (state law maxes the premium, so an insurance company could NEVER recover in premium what they would have to pay out for all of the surgeries.

Insurance generally only pays for WLS if a "self-funded" company who pays most or all of their own claims TELLS them to. Becasause the company is paying for the surgery NOT THE INSURANCE COMPANY!!!!! The insurance company for these groups only ADMINISTERS the claims.

Companies choose to pay for this because in the long run - you will probably cost them less money to have the surgery than you would to them with all of the health problems that being overwieght would cost.

Sorry for my soapbox - this just comes up all of the time and there is a BIG misconception about how insurance really works. There are some exceptions to this, but for the most part, this is how it works.

I am an insurance consultant to large companies and help employers write their policies regarding WLS. There is a lot of debate in the consulting community right now about continuing to cover WLS. Mostly because of the cost of complications with gastric bypass - long term malnutrition and things of that sort. I hope that the band does not get thrown into that, but it probably will.

I had to sit in a very heated debate about this with a group of employers without anyone in the room knowing that I have gotten a band. It is very well known that hospitals and bariatric centers are capitalising on this trend and it is becoming a HIGE money maker. If insurance stops paying for this so wide spread, it will drop the price dramatically for those of us that are self pay here in the states. (just a fact - not trying to say that it should happen)

[Infaith 1]

You are right Soonergirl. It is the company that you work for that makes the decisions on what is included. Sorry that my post was so negative regarding insurance. I was very frustrated because of high co-pays (doctor visit was $45) and after going to a couple of wls information seminars....nobody had good luck with getting ODS to pay for wls or anything else to do with weight loss. This included people at other jobs that had ODS, but different policies and other companies. Again, sorry. Thanks for setting the record straight.

[Veranda Cannon 0]

You are right Soonergirl. It is the company that you work for that makes the decisions on what is included. Sorry that my post was so negative regarding insurance. I was very frustrated because of high co-pays (doctor visit was $45) and after going to a couple of wls information seminars....nobody had good luck with getting ODS to pay for wls or anything else to do with weight loss. This included people at other jobs that had ODS, but different policies and other companies. Again, sorry. Thanks for setting the record straight.

I have ODS OEBB insurance and it won't pay for ANYTHING! I was told that anything related to weight loss is "cosmetic" and a direct plan exclusion. As started above it's ok to pay for sleep apnea and diabetes, but heaven forbid they pay one time now so that I can avoid trouble later.

[SageTracey 608]

In Australia my banding was almost entirely covered by private health insurance, just $1,000 out of pocket expenses. And Medicare covers fills and follow up appointments.