LJBravado

Hello everyone! Reading the subject line sounds like a no-brainer, doesn't it... I'm wondering if anyone has had any experience, or has any thoughts on how to deal with US doctors and insurance companies who know - or who might need to know - that you had surgery in Mexico. Does anyone know if there are any laws that protect us from discrimination by doctors or insurance companies for that reason? I had a slip a few months ago and am fighting with my health insurer to cover the slip surgery. Thing started to unravel when I had to tell them last week that I pay cash to the doctor I see for fills. Talk about awkward. Things got more complicated when I consulted with the law firm (obesitylawyers.com, if anyone ever has questions on that subject) who I hired to help me with my appeal. My health insurance company didn't ask me about my (cash) fill doc's records [yet], but what I've learned now is that my fill doc does -not- keep records on cash patients at all. Which, according to the lawyer, is illegal. Gulp. I have a sinking feeling that if my health insurance company finds that the doctor who was treating me prior to my slip was doing something illegal, it's going to reflect pretty poorly on me and my appeal. Taking this one step further leads me to question what would happen when the insurance company found out that my original surgery was in Mexico. I'm thinking this would end my appeal for sure, whether its right or wrong. I have to admit, when I opted for surgery in Mexico I didn't realize that any of this could be an issue later. Don't get me wrong... it's still worth it, I would still do it again in a heartbeat. I welcome any thoughts that anyone has on the topic... Thanks, and much success to all, Laura

That is the first time I've seen a correlation between the patient's BMI and the size of the band they receive, or that the size of the band would prevent slippage. Did your doc give you any additional info on that? My slip was due to being too tight, and vomiting too much. I know that other things can cause it, but from what I've read, that seems to be the biggest issue. I definitely don't mean to suggest that the information is inaccurate - I'm always learning more and this was new info for me, so I'm curious. And my own two cents about success - believe in the tool. I'm 2 years post-op, at goal, and although I did have a slip, it's still the best thing I've ever done. I did WW for years, did everything like you're supposed to, but still had 75 more to lose. So frustrating. This is so different from that scenario. Think positive - you will have success!! :clap2: All the best! Laura

Hi there - I went to Tijuana and had Dr. Kuri and his team two years ago. He and his staff were great, I highly recommend him. I did call him a few months ago, I've had some bizarre issues with my feet swelling (but it doesn't seem to be related to the band). When I called their offices they put me right through to him. He is very caring - far more than any doctor I've had in the states. Just three weeks ago my band slipped and I had to have emergency surgery, traveling to Dr. Kuri wasn't an option, which is tragic on two levels, first because my insurance won't cover it and the bill is $17,000 (almost twice what I paid Dr. Kuri) and also because whoever did my stitches did a pretty sloppy job on one incision. Please feel free to contact me further if you have more questions about Dr. Kuri - I don't believe I've read a single piece of bad press about him. Much success to you! Laura D. DOB 10/1/05 Dr. Kuri 248 / 145 / 135-ish?

That's the bill I got from the hospital and surgeons for moving my band back into place after a slip. I had been too tight for months and threw up WAY too often. My insurance will not pay a dime. I'm going to have to fight like hell and hope that I can at least negotiate with the hospital and doctors. Please, learn from my very expensive, dangerous mistake. Wow, I just realized my second bandiversary was Monday. Yeah!! One other word to those considering this, in my opinion, even if it cost $60,000, I'd do it again a thousand times. It's still worth it. Much success, Laura D. 243/145/140 DOB 10/1/05 Dr. Kuri

In my experience - and I seem to have a lot of it since I just had a slip and spent WAY too much time throwing up - once you vomit your stomach is irritated. It's important to back off and stop trying to get food down. Go back to liquids for a day or so - then mushies. Give your stoma time to go back to normal. What ever you do - don't force it. And stay calm. Stress can also cause increased restriction. All the best, Laura

I had an excellent experience with Dr. Kuri. You can also check out his yahoo groups for more info... Much success to you!

Hi Teri - What did your doc mean regarding patients 2 years post op? I am almost 2 years to the day and had a slip on Wednesday. It was repaired, thankfully. I would be devastated if I lost my band forever... Also, which band do you have? Thanks!

My situation was severe, so I'm not sure that this will help. I was 100% obstructed, so I couldn't keep anything down, not even Water. I also had acid constantly building in my esophagus and had to throw it up every 15 minutes or so. Finally, when I did throw up, it was very violent, like when you have the flu, not like a "normal" PB, which for me was very gentle. If you suspect a slip see your doc as soon as possible. You may also just have too tight a fill, which is easily remedied. Much success to you! Laura

Oh my God - you are right to be suspicious. You should not be losing that fast, should not be losing your hair, should not be throwing up and should NOT have acid reflux. See another doc - pronto. Best of luck to you! Laura

After re-reading the posts, I find it interesting that I am also at around the 75lb loss mark (my total loss is 110lb., I lost a good bit before my banding)... has anyone seen a common thread between that 75 lb. loss mark and a slip? I wonder.... Laura D. DOB 10/1/2005 Dr. Kuri, TJ

I went to the ER Wednesday in severe pain - my band had slipped and my stomach was completely obstructed. I was vomiting acid for over 24 hours. The good news is that they fixed it right up - just went in and put it back where it was supposed to be, and added a few stitches to boot. For me, the bad news is that my insurance has rejected the entire claim, so I'm going to have to fight a battle. Still, though, if I had to choose between being back where I started 110 lbs. ago or shelling out $10k and the pain of the slip, I'd choose the latter. The band has changed my life - it's the best thing that's ever happened to me and worth every effort. All the best to you - don't worry. You'll be just fine! Laura D.

I should have clarified - the insurance company doesn't seem to care who paid for the procedure originally - their policy is that the won't cover -anything- having to do with weight loss surgery. I will definitely appeal, and thanks to all for the suggestions! I still argue that the situation was an emergency, although that may hold more meaning for me than for them. While it is definitely scary to face a possible $10k+ medical bill, I still wouldn't change a thing. For GR8 - my slip was undoubtably caused by too much vomiting. Although I can't say for sure when the slip began, I had several occasions where I'd be OK one day, and too restricted the next. My fill doc is 2.5 hours away, so I tended to be "OK" with vomiting more than I should have, not really heeding the warning that too much vomiting can cause a slip. I take responsibility for it, although they can happen without the vomiting, I would say that most slips are a result of vomiting. For anyone who thinks that it won't happen to them, think again!! I will say that the slip was FAR more painful than the original surgery. I will be very careful not to have it happen again, not to mention if it were to happen again, I might lose my band entirely, which would be devastating. I can't imagine not having it. I'm so grateful for these message boards - thank God we all stick together. Heaven knows the insurance companies aren't necessarily looking out for us. Much success! Laura

I realize that I posted this in the wrong section... So I have known all along that my health insurance company does not cover lap-banding, or appointments that go along with it, i.e., fills. I'm sorry to say that I had a slip - and a bad one, this week and ended up in the ER. I was then admitted to the hospital where they did emergency surgery and re-positioned my band back to where it's supposed to be. Thank God everything went great and they didn't have to remove or replace my band, and I was able to come home Friday. My insurance company has completely denied the claim, and although I realized that this could happen, I do wonder if anyone has had this experience and appealed with any success based on the fact that, while the lap-band itself is an elective surgery, the repositioning was an emergency situation that they might at least cover part of? This also makes me wonder if a person has a tummy-tuck or other cosmetic surgery, do insurance companies also deny any illnesses or issues that arise due to these elective surgeries? Are there additional insurance policies that a person should take out to cover these things? Finally, has anyone had the band repositioned and paid out of pocket? What was your cost? Thanks to all for your input. On one hand I accept full responsibility for the surgery and the cost of maintaining it, but on the other hand it infuriates me to no end to know that if I had gone to the ER with a heart attack or diabetes because I was obese they would have covered the claims without a peep. That seems so wrong. Much success, Laura 243/145/140 DOB 10/1/05 Dr. Kuri, TJ

:help: So I have known all along that my health insurance company does not cover lap-banding, or appointments that go along with it, i.e., fills. I'm sorry to say that I had a slip - and a bad one, this week and ended up in the ER. I was then admitted to the hospital where they did emergency surgery and re-positioned my band back to where it's supposed to be. Thank God everything went great and they didn't have to remove or replace my band, and I was able to come home Friday. My insurance company has completely denied the claim, and although I realized that this could happen, I do wonder if anyone has had this experience and appealed with any success based on the fact that, while the lap-band itself is an elective surgery, the repositioning was an emergency situation that they might at least cover part of? This also makes me wonder if a person has a tummy-tuck or other cosmetic surgery, do insurance companies also deny any illnesses or issues that arise due to these elective surgeries? Are there additional insurance policies that a person should take out to cover these things? Finally, has anyone had the band repositioned and paid out of pocket? What was your cost? Thanks to all for your input. On one hand I accept full responsibility for the surgery and the cost of maintaining it, but on the other hand it infuriates me to no end to know that if I had gone to the ER with a heart attack or diabetes because I was obese they would have covered the claims without a peep. That seems so wrong. Much success, Laura 243/145/140 DOB 10/1/05 Dr. Kuri, TJ

So, do you think that it might go back to normal once my body has had normal food for awhile? Craziest thing I've ever seen, although what you say does make some sense. Thanks for your thoughts - I just want my "skinny" ankles back!! :clap2: