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Washington state self-pay?

I want to have my insurance pay for a revision from banding to sleeve because of issues with my band, but I'm not getting my hopes up (my BMI is currently 33). I want to be prepared to self-pay if I need to, so I'm trying to find a surgeon that is priced in my price range if I need to pay out of pocket. I'd like to stay in Washington, if possible, but am willing to travel if I can't find a good, affordable surgeon for self-pay. If all else fails, I'll head to Dr. Aceves in Mexicali, Mexico.

I've looked into Dr. Billing at the Puget Sound Surgical Center, and I found Dr. Srikanth's website last night. Anyone know their prices for self-pay?

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  • What about asking Dr. Billings how much he would charge you for self-pay of the sleeve if he billed the band removal to insurance. You would only be paying for the extra OR and anethesia time that wa

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I believe Dr Billing and Landerholm are around $16K for self-pay. I did not use either of them, but I have heard nothing but great things.

A rough estimate for Srikanth is ~$21,500 and that total includes BLIS (WLS Insurance).

If you want to stay in the states. I can keep you updates as I go through my long distance surgery option. (friend me)

Dr. Pleatman is in Michigan... he specializes in Out of State Patients the link is his self pay information its about 14K

http://drpleatman.com/weight-loss-program-alternate.htm

Good Luck!

  • Author

Ouch, $20k+ is way, way out of my price range.

I think I will probably wind up self-paying. My insurance (Federal BCBS) has the following for the requirements for subsequent WLS:

− All criteria listed for the initial procedure must be met again

− Previous surgery for morbid obesity was at least 2 years prior to repeat procedure

− Weight loss from the initial procedure was less than 50% of the member’s excess body weight at the time of the initial procedure

− Member complied with previously prescribed postoperative nutrition and exercise program

<br><br>I meet the last three requirements, but I don't meet the initial criteria anymore, so I doubt that my insurance will pay for the band. They may cover the removal of the band, but they aren't going to cover the sleeve surgery. Sucks. Guess I'm going to be saving money for a while, or taking out a loan.

I'm leaning more and more towards going to Dr. Aceves in Mexicali. His price is definitely more in line with what I'd like to pay. I know he's very experienced, very good, and I know that Dr. Billings has seen his patients before, so I'd have a local doctor for follow-up.

They may cover the removal of the band, but they aren't going to cover the sleeve surgery.

What about asking Dr. Billings how much he would charge you for self-pay of the sleeve if he billed the band removal to insurance. You would only be paying for the extra OR and anethesia time that way. Never hurts to ask!!!

  • Author

Well, I bit the bullet and made an appointment with Dr. Billing. We're going to start out with just checking on my band and seeing what's going on with it, since I haven't been able to see my original surgeon for over 2 years. Keep your fingers crossed that my insurance decides that they're willing to pay for all of this.

I have to say that I get a very good feeling from the coordinator. She's very nice and caring on the phone, so I'm hoping the surgeon is the same way.

  • Author

What about asking Dr. Billings how much he would charge you for self-pay of the sleeve if he billed the band removal to insurance. You would only be paying for the extra OR and anethesia time that way. Never hurts to ask!!!

You know, I hadn't thought of it that way! I'm hoping this works!

Keep us posted ... I'm sure they can work something out for you. FINGERS ARE CROSSED!

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