Does anyone know?...insurance ??

RHCPgirl · August 6, 2006

I was planning on being banded in Mexico in Sept. I had finally made up my mind but then my mom's friend (who is a nurse) said she wouldn't recommend it. She said that if I were to have complications and had to go to the dr or hospital my insurance wouldn't cover it and could actually drop me for have a procedure out of country. Is that true? Any info would be appreciated.

Thanks,

Coreen:help:

Bettina · August 6, 2006

Insurances are funny that way...you just never know.

Personally I would not have surgery out of the country. Especially all the horrors you hear on this board, I wouldn't risk having something wrong and not having the doc who did the banding looking into the problem. Even if it were self pay and i had to pay the extra, its worth my life.. is it worth yours?

I am extremely lucky that I found a doc 25 mins away.

All the best in whatever you decide.

RHCPgirl · August 6, 2006

It's not about the money, it's more about the experience for me. Eventhough saving $10,000 is tempting: ) The dr I consulted here has only done like 50...but the dr in Mexico has done 3,000. I'm only 2 hrs away from the dr in Mexico, but am worried about the being dropped from insurance. How do you think I can find that out? Thanks for advice it is something to think about.

kodeys mema · August 6, 2006

My daughter, myself, sister and neice all went to Mexico to have the band surgery. We all did fine through the surgery, but my daughter had so much more pain than the rest of us. She even said to me "she thought she was bleeding internally" We had surgery on Monday and stayed in the hospital until Wednesday and flew home that afternoon. She still felt really bad. Friday she called me. She was in terrible pain and was trying to get to her family doctor. I told her to go straight to the ER. She did and they found that she had a 8 ounce blood clot in her abdomen. They started her on antibioticsand watched her for four days. They did emergency surgery on her Tuesday nite. She made her doctor promise not to remove the band. When he got in there the infection was horrendous. Her colon was turning black and he almost removed it then and there. But a little voice told him to give her a chance. But the band came out. To shorten my story and answer part of your question. She was in intensive care for 8 days fighting for her life. And in the hospital for 28 days. Her insurance did cover it. The rest of us are fine and losing weight. My daughter is happy and thankful to be alive, but does wish to have the band put back on.

RHCPgirl · August 6, 2006

How scary that must have been....I'm glad to hear she's doing well. That's good to know that the insurance covered it. It didn't sound right to me that an insurance company could drop you for having surgery that they won't approve...but better to ask then to find out too late.

Alexandra · August 6, 2006

RHCP, no carrier would be able to drop you for having a surgery they didn't "approve" of. In some states, carriers are permitted to deny initial coverage for WLS patients, but if you are already covered you can't summarily be kicked off the plan.

Carriers can exclude routine followups for a surgery they exclude, so fills wouldn't be covered if your initial banding wasn't. However, emergency care would have to be covered no matter what the genesis of the emergency.

In general, If any treatment is provided for a true medical emergency, I can't see any insurance carrier denying payment for that treatment.

Bettina · August 7, 2006

It's not about the money, it's more about the experience for me. Eventhough saving $10,000 is tempting: ) The dr I consulted here has only done like 50...but the dr in Mexico has done 3,000. I'm only 2 hrs away from the dr in Mexico, but am worried about the being dropped from insurance. How do you think I can find that out? Thanks for advice it is something to think about.

I would call your insurance and ask them their policy. If you are a self pay--they certainly can't drop you. But if they don't cover the procedure at all you could be considered an insurance risk. But dont' go by what I said, for peace of mind, call them, it can't hurt.

Okay this is strickly food for thought and not in anyway to insult or make anyone feel bad but after reading the above post it validates my personal feelings: ugh here goes: 3,000 is a high number....how many a day, how many a week, is this too many? Is it like get them done and get them out? I don't know all the statistics but I'd question that number. Maybe Doctor #50 has had perfect out comes? Like I said just something to think about. My doc has done several hundred, but no rebandings, no slippage...no infections ....nothing but success.

(of course these are the ramblings of someone who has been reading these posts like crazy and has been reading some pretty horrible stuff... and I now think...yikes.....do I want this?) (yeah I still do, but I have more concerns...which I will pass on to the doc!)

Best Wishes to you!

RHCPgirl · August 8, 2006

Thanks for all the help: )

Bettina - I know what you mean about reading all these posts...some scary stuff out there. The reason the Mexico dr has done so many is because it's been approved in other countries for 9 yrs now and only been approved here for 3 yrs. Dr. Ortiz wrote a book that I hear is very informative...Lap Band for Life. It's probably mostly info we can get from here, but I'm figured any info is helpful. I'm scheduled for surgery on Sept 11th and starting to get cold feet once in awhile. How about you...are you scheduled yet?

Bettina · August 9, 2006

Thanks for all the help: )
Bettina - I know what you mean about reading all these posts...some scary stuff out there. The reason the Mexico dr has done so many is because it's been approved in other countries for 9 yrs now and only been approved here for 3 yrs. Dr. Ortiz wrote a book that I hear is very informative...Lap Band for Life. It's probably mostly info we can get from here, but I'm figured any info is helpful. I'm scheduled for surgery on Sept 11th and starting to get cold feet once in awhile. How about you...are you scheduled yet?

Hi,

I didn't know about Dr Ortiz being certified way earlier than the other docs....i understand now! lol Yeah, I have been planning on getting that book for a few weeks now. I have not been scheduled yet....pulmonary doc (you can read my journals for the details) office is giving me a load of crap.....can't have surgery until i am on cpap for 2 weeks...pulm doc yanking my chain....ugh sorry...I am just so pissed off. I called them today, they never called me back. I am supposed to be studying for my spanis final.....I may just take the hour drive to give nurse-zilla the stare down tomorrow!!! I will let you know when I get my appt!!! take care!

dpingl · August 9, 2006

HELP! I have to change jobs, an opportunity has come along I can't resist BUT I have been approved for band @ my current job... See Dr Monday.... it will be at least 3/4 weeks before surgery! I am thinking COBRA, just to make sure my band gets coverd!

RHCPgirl · August 12, 2006

Bettina - I hope you had good luck with your stare down and spanish final...lol. Just wanted to let you know that I just got the book and it's very informative. A must have for anyone thinking of getting the band.

Take Care