Sepf-pay needs advice from post-op insured bandsters

[ncarreras 0]

Hi,

I will pay for my surgery and I am a little concerned that my doctors are not requiring me to do certain things that insurances ask for our own good. For example, I am not required to have a psychological eval, lengthy pre-op diet, more nutritional counseling (only one), and some of the tests that other insurances require. I will talk to my family doctor about this on Wednesday to see if he may recommend some things. But I thought it would be good to get your opinion.

I am readnig an excellent book on WLS and this surgeon talks about the many patients he sees who are not able to cope with WLS because they never worked on psychological issues. Others had hernias or other conditions that could have been detected pre-op.

Thanks!

[Brittany8018 0]

I ended up self-paying for my surgery after insurance denied me, several times. In order to file with the insurance company, I had already jumped through all of their hoops, including the psych eval, and 6 month supervised diet. I can honestly say that the nutritionist who did my "supervised diet" was not very helpful, I learned much more in the one visit with the nutrionist my surgeon recommended! (But that's just my personal feeling).

Also, I will say that I had a hiatial hernia (as discussed in your book), which was not detected pre-op, but it was repaired, even though I was a self-pay patient!

I think it really depends on the surgeon and the program they're associated with. And not as much whether you self-pay or go through insurance.

[bestbette 0]

I agree. I was also self pay and had hernia repair during surgery that was just rolled in. My Dr. did require a pre-op psych visit, but oddly enough my insurance did pick up that with only a $20 co-pay. I had to go through the pre-op diet along with everyone else but I think that's pretty standard. If you're worried about the psych piece seek out someone independently that does weight loss or body image counseling and go...couldn't hurt.

[RestlessMonkey 7]

Honestly my psych eval was a great big joke. But if you want to pay for one on your own I'm sure you can! Aside from almost a year of behavioral therapy on my own before I even decided to get the band (when I say I tried everything, I mean it; including hypnotism) anyway...I know myself better than any 1-hour psych eval could ever show, did my research, soul searching, etc and was ready. If you aren't sure you want the band, don't get it! IF you feel you need more tests and are getting rushed through (and that is possible) find another surgeon.

I didn't have to do a lengthy 6-month eval and honestly that's a waste too, for some of us. Some decide to cancel the surgery (which I'm sure pleases the Ins. co) I've done WW for years, I've done Jenny, I've done Atkins and Nutri systems and a thing in the 70's called Medical Weight Control. The last thing I needed was another 6 months of dieting, but we're all different. If you feel you need to give it one last try then you know yourself best; do that. Join WW and give it your all, (or some other organized diet).

[ncarreras 0]

Thank you for your replies. I think I will ask my PCP to suggest any tests that he feels appropriate. Will also talk to a counselor to schedule a couple of sessions to explore my eating patterns (not for the eval, I agree that is pointless) . I was just curious. It seems like when you are self-pay, they don't screen well enough. It could also be the fact that my BMI is only 40 and I have no co-morbidities... not sure. Thank you all!!!

[~Michelle~ 0]

I am self pay, and I had to do the phyc eval, which I thought was kind of a joke also. I did not have to do a lot of the other things that insurance requires. Only tests I had to do were the simple routine blood tests. The only pre-op diet I had was the 2 week liquid diet. My surgery went fine, and to be honest the phyc eval didn't do anything for me. I think the surgeon just wants to make sure that if you have any issues like eating disorders, or depression that they are dealt with as well. That's how the phy explained it to me.

[716KellyG 0]

I was self pay and was required to have psych eval, nutritionist appt, and 2 week pre op diet...everything my doctor requires of all his patients......trust me the ins co are not making people jump hoops because it is the right thing to do--- it helps elimate the ones who are not dedicated to the process....

[mominkansas 2]

I am insured and was shocked at how smooth it went. I went in April for my informational meeting and had none of what you mentioned, then had my surgery in May

[NJMOMof2 17]

I have insurance and the psy eval was a big joke. I visited with the nutritionist once. I think the most important support is online and a monthly support group. My doctor did not require a pre-op diet, other than liquids a few day before surgery.