Pre-op, self pay. So many questions

[Guest deliacat]

Hi there. I have been lurking for awhile, but finally decided to sign on and participate. I recently decided to have weight loss surgery after being overweight for all of my life. I cannot remember a time when I wasn't overweight to some degree, despite being very active, and trying numerous diets. My mom had Gastric bypass a few years ago, and is doing great, and my sister is contemplating the same. For me, I don't have any co-morbidities, and my BMI is just 40, so I am leaning toward the lap band. My initial consultation is scheduled for next week. Here's the thing, I have health insurance, but they want to dictate where I have the procedure, and let's just say I'd rather not have a lap band done where I work (I'm an RN) not only for privacy reasons, but also because they are not a center for excellence. So I'm planning on self paying and having the procedure at a hospital other than the one I work at.

So, on to the questions:

1) For self payers - did the BMI/co-morbidities come into play less for you than for someone having it paid for by insurance? That is, if I weigh in at my consultation next week and am a little under a 40 BMI with no co-morbidities, will they automatically deny me?

2) Again for the self payers - Did your insurance help you at all with all of the pre-op testing, ekg's etc?

3) For everyone - Did you have the choice whether or not to stay overnight in the hospital, or was it up to the surgeon? I really don't want to spend the night in a hospital for a whole host of reasons, not least of which is the money.

4) Also I am planning on moving in the next year or so. If I change insurance companies, would the new insurance pick up the cost of fills, etc. if I had paid for the surgery myself initially?

That's all I can think of now. I'm sure a million more will come up after I go for my consult next week. Thanks in advance for your answers!

[donna12 742]

I can only answer 2: hospital stay, I think it's up to your surgeon, for me I was in and out same day, no complications. Insurance question, I had BCBS-MI at the time with my ex and it was running out due to divorce so they pushed my surgery thru quickly so it would be covered. Within 2 weeks I had Anthem BCBS-KY and they do cover my fills and office visits but my independent paying insurance isn't as good as my old one was.

[KAATNS 1,473]

At the center I use, BMI dictates if you will be eligible for surgery and being self-pay I didn't have to jump through all the hoops to get approved. Insurance paid for my pre-op testing and consultations and I did not require an overnight stay. I think that would be up to the surgeon and how you do post-op. I'm not sure if your new insurance company will cover the cost of aftercare/fills. A lot of that depends on how your visits are coded by the doctor. The cost of my surgery included 2 years of aftercare. Best wishes to you!

[Toddy 758]

I can only answer half of 4. I moved and changed insurance shortly after surgery and my new insurance does cover my fills. Insurance also paid most of my surgery though. Not sure how the new insurance company would determine if you were self-pay or insurance paid.

That being said, EVERY insurance policy is different. With my first WLS surgery I had BCBS Maryland, and they paid 100%. With my second surgery, I had BCBS Tennessee and I had to pay roughly $1500 out of pocket. My daughter has BCBS Tennessee and her insurance has a clause that it will not pay anything for WLS...

[2muchfun 8,928]

#4-Insurance will pay if there's a bariatrics rider on the policy. If not, probably not. Also, after care is as important as the surgery itself. Make damn sure you have a safety net in the city you move to or you could be very disappointed. We've seen dozens or hundreds of posts from folks who moved and couldn't find a fill doc or the practice wasn't as supportive as the original doctor. There are few doctors who want to take on the responsibility of caring for a patient they didn't operate on. There's not much money in lapband surgeries and even less in fills. tmf

[Amp1504 7]

I am a self pay and my bmi is around a 38 and I didn't get denied. My insurance paid for most of the psych eval(other than a copy) and the rest of my tests are included in my package price. I'm having my surgery done at a surgery center so it's outpatient. Good luck!

[GuyMontag 1,264]

Hi there. I have been lurking for awhile, but finally decided to sign on and participate. I recently decided to have weight loss surgery after being overweight for all of my life. I cannot remember a time when I wasn't overweight to some degree, despite being very active, and trying numerous diets. My mom had Gastric bypass a few years ago, and is doing great, and my sister is contemplating the same. For me, I don't have any co-morbidities, and my BMI is just 40, so I am leaning toward the lap band. My initial consultation is scheduled for next week. Here's the thing, I have health insurance, but they want to dictate where I have the procedure, and let's just say I'd rather not have a lap band done where I work (I'm an RN) not only for privacy reasons, but also because they are not a center for excellence. So I'm planning on self paying and having the procedure at a hospital other than the one I work at.

So, on to the questions:

1) For self payers - did the BMI/co-morbidities come into play less for you than for someone having it paid for by insurance? That is, if I weigh in at my consultation next week and am a little under a 40 BMI with no co-morbidities, will they automatically deny me?

2) Again for the self payers - Did your insurance help you at all with all of the pre-op testing, ekg's etc?

3) For everyone - Did you have the choice whether or not to stay overnight in the hospital, or was it up to the surgeon? I really don't want to spend the night in a hospital for a whole host of reasons, not least of which is the money.

4) Also I am planning on moving in the next year or so. If I change insurance companies, would the new insurance pick up the cost of fills, etc. if I had paid for the surgery myself initially?

That's all I can think of now. I'm sure a million more will come up after I go for my consult next week. Thanks in advance for your answers!

1) If you pay you get banded. No BMI or comorbidities factor in.

2) Generally if insurance says no then no. With my surgery it was all inclusive with the self pay and there were no tests prior to surgery.

3) I did not stay overnight and that is unusual in my doctor's practice.