Anybody have a leak?

[txaggiemom 0]

I see my Dr. for the first time this Friday and am so glad I found this forum. I was originally checking into RNY until I did more research and found this forum and I think the VSG is the way to go, but I was wondering...

I am paying cash, but what happens if you have a leak and you are a cash pay. Could you end up with an astronomical medical bill? At one point does you insurance cover side effects. I am thinking what if 2 years down the road you have some scar tissue and have to have something done about it?

[suryfer 0]

Hi, congrats on your surgery! I have my surgery done on Feb. 11th. I will be getting it done in Houston, TX. How do you feel after the procedure?

[Tiffykins 672]

You would have to discuss what complications would be covered by your insurance. I know some people who have had complications that were self-pay, and some of the hospital bills were covered under their insurance. It all depends on how they code the bill. If your insurance company excludes weight loss surgery, then more than likely they will not cover a secondary surgery to fix a complication that followed an excluded service. Also, since you are paying cash find out from the surgeon if any complications would be covered under his follow up care plan.

[i1Linda 15]

Yep - what Tiff said. I was self-pay and knew that it was a risk I was taking. My insurance wouldn't pay for anything related to it. However, my insurance did pay for a CT w/ contast done post-op. I was having back pain and we wanted to rule out a leak and see if anything else was going on in there. It was coded as back pain (because that was my symptom) and was covered without incident.

[Itstime 0]

That is my question also. I am a selfpay and thank heaven I haven't had any complications, 8 weeks out, but when I go for my 3 month check up with my PCP I am to have an upper GI x-ray. Can I get past the insurance with say stomach issues? I have Cigna.

[i1Linda 15]

That is my question also. I am a selfpay and thank heaven I haven't had any complications, 8 weeks out, but when I go for my 3 month check up with my PCP I am to have an upper GI x-ray. Can I get past the insurance with say stomach issues? I have Cigna.

I am not familiar with Cigna, however, I would stay away from anything coded as post-op WLS and anything "routine".

[Oregondaisy 2,019]

When I saw my band surgeon, I told him my ins. would not cover anything band related, and they coded it for heartburn, which was what I saw him for. My ins. paid the office call.

[Plumbum 0]

I asked my insurance if they would cover complications (I am self pay also and my insurance has a WLS exclusion) and they said, since I do not have a pre-existing condition exclusion that they would pay for any incidences. Of course, I have not had my surgery yet and have not put that to the test ( I hope I won't have to...).

[txaggiemom 0]

Thanks everyone for your replies. I guess I better just cross my fingers and hope for the best. I have United Health Care and WLS in excluded.

Suryfer - I have not had the surgery yet. My very first doctors appointment with the surgeon is this Friday.

[Inside2Out 0]

I have Blue Cross Blue Sheild of Texas and WLS is excluded. The insurance company stated they would NOT cover ANY complications post-op, regardless of what they are. I, too, have to cross my fingers and hope for the best. Otherwise, I will be stuck with a HUGE bill...and I do mean HUGE!!! Good luck to you.

[txaggiemom 0]

Inside2Out - have you picked a surgeon yet?

[thinoneday 445]

I see my Dr. for the first time this Friday and am so glad I found this forum. I was originally checking into RNY until I did more research and found this forum and I think the VSG is the way to go, but I was wondering...

I am paying cash, but what happens if you have a leak and you are a cash pay. Could you end up with an astronomical medical bill? At one point does you insurance cover side effects. I am thinking what if 2 years down the road you have some scar tissue and have to have something done about it?

Hi and welcome! I asked that exact same question to my doctor and since i was self pay, I thought the same thing too. . . but he told me that they code it as an emergency procedure and it's collected on insurance. . . but that is what my doctor said, your's may be different. . . and also with plastics after you lose all your weight, my doctor said he makes it a emergency procedure like excess skin causing infection and breakdown . . . then insurance will pay for it. . . there are tons of ways around things he said. . .

[Inside2Out 0]

TXAGGIEMOM - My surgeon will be Dr. Sashidhar V. Ganta with Austin Institute of Bariatrics and Laproscopy.

[judygettinsmaller 0]

Hi, I am a self-payer also, here is a little background, had Blue Cross/Sheild PPO but WLS was excluded. Had the sleeve Dec. 14, 2009, about 4 weeks out I developed Gallstones, however on Jan 1, 10 we changed insurance to Blue Cross HMO, so I went to my PCP (which knew I had WLS cause I had all my pre-ops through him, and the PPO paid for that.) He ordered an Ultrasound, got a referral to the surgon for Gallbladder surgery which I had on Jan. 26th. I think I was lucky it was covered.

[MINI-Me 196]

I think it would be pretty hard to say gallstones are a direct result of WLS. I'm not too concerned about those kind of issues. I would be concerned about a leak though - that's been on my mind a lot since I am also self-pay.