Surgery costs mega $$$

NancyRN · August 8, 2006

I'm freaking out about the total cost of all surgery-related care! Had my first consultation last week. Had been doing OK with cost of surgery -- my insurance covers 90% and I could scrape together the 10% I'd have to cover. But...the surgeon said I'd need to spend 1 or 2 nights in ICU because I have sleep apnea (mega $$$ for ICU care), plus he wants an unbelievable list of preop tests (echocardiogram, abd. ultrasound, colonoscopy etc. -- mega $$$ for all). I'm scared it will add up to so much I can't afford it. Borrowing it isn't an option -- we're in debt up to our ears because my husband's one-man company is failing.

Do you have any tips for finding out how much all this will cost? And any tips about paying for it?

NancyRN

Elisabethsew · August 8, 2006

All the pre-op tests should be covered by your insurance and yes, most people do have to have all of those tests. I needed an endoscopy, pulmonary consult, pulmonary function tests, chest x-ray, cardiac consult, stress test, echo, thyroid function tests, nutrition consult, psych consult, medical clearance, etc.

I don't have sleep apnea but had my surgery the same day as a male patient who had severe sleep apnea. His surgery was right before mine (I was the last case of the day) and we both spent the night in a telemetry unit (all lapband patients do) and we both left the next AM. A two day stay in an ICU seems excessive. Maybe your MD is mixing you up with a gastric bypass (Roux-n-y) procedure?

Check out other surgeons in your area.

diva · August 8, 2006

First of all where are you located? Second-I have sleep apnea, I did not have to stay overnight. As for the pre-op tests, they sound like a lot but I don't know your medical history. If you have regular insurance than your PCP can order a colonoscopy for you-you should have one anyway at age 59. Most insurances will pay for this as a base colonscopy at your age (in fact you probably should have had one before this). Find out if the tests he wants you to have would be covered by a regular physical. Find out what your insurance will pay for exactly-call them, get the name of the person and have them send you their wls policy in writing or find it on their on-line site. Then find out where else in your area you can get banded-shop around. The prerequisites are so varied its staggering. Get all your facts.

Dody · August 8, 2006

All the pre-op tests should be covered by your insurance and yes, most people do have to have all of those tests. I needed an endoscopy, pulmonary consult, pulmonary function tests, chest x-ray, cardiac consult, stress test, echo, thyroid function tests, nutrition consult, psych consult, medical clearance, etc.
I don't have sleep apnea but had my surgery the same day as a male patient who had severe sleep apnea. His surgery was right before mine (I was the last case of the day) and we both spent the night in a telemetry unit (all lapband patients do) and we both left the next AM. A two day stay in an ICU seems excessive. Maybe your MD is mixing you up with a gastric bypass (Roux-n-y) procedure?

Check out other surgeons in your area.

Not always correct!! I have severe sleep apnea. I spent the night in a regular hospital room not hooked up to anything. I was never required to have a colonoscopy (never heard of one being required). I have many medical problems including having had open heart surgery, so if anyone should have had to be followed closely it would have been me. I had great care, but certainly just stayed the night and went home, not hooked up to anything. I needed clearance from my cardiologist, an EKG, thallium scan, psych eval, letter from PCP, sleep apnea study and a couple other things, but certainly have never heard of anyone with sleep apnea having to spend the night or 2 nights (eek Gods) in ICU. That is beyond belief. Please don't speak for all of this, as I wasn't required to do most of this stuff, and many people are not. I also wasn't required to have an endoscopy. It was never, ever mentioned. I had a top surgeon at Vanderbilt and never had one bit of a problem. Sounds like money gouging to me. Find another surgeon.

GayleTX · August 8, 2006

sounds like 'somebody' is on the $$train!! The requirements are usually requirements of the insurance carrier, not necessarily the surgeon. I'd talk to the customer service at the insurance company first. I too had multiple medical problems including sleep apnea and heart trouble (several stents, high bp, etc) and I was at the hospital about 2 hrs. after the surgery. Talk to the insurance company yourself!!

WhimsicalClay · August 8, 2006

My surgeon also requires a lot of pre-op test. While my insurance company does not cover any weightloss surgery, they did cover 100% of all the testing I've had done...including an EKG, echo, ultrasound, bloodwork, chest xray and I'm probably missing one or two. I was required to see a nutritionist as well as go to a cardiac rehab center and exercise. All of this had to be documented and returned to the surgeons office before he would even schedule a date for surgery.

I forgot to mention that I am self-pay!

Check with your insurance company. You may only have to pay the co-payments, seems to me if they are paying for the surgery, they'd pay for the pre-op testing as well.

The doc I'm using also requires about 5 pre-op meds which insurance also paid. Once again, I just had to pay the co-pay.

cashley · August 8, 2006

It seems each doctor is different.... one doctor I almost went to required a sleep study but it was included in the fees (I was self pay). It wasn't in the ICU at all.

I ended up going to a different doctor that had all the cost in one package. I didn't have to do the psych eval or the sleep study but did have the barium swallow, chest x-ray, ekg, nutrician consult and blood work. It was all done in one day and they made it really easy.

joliesmom · August 8, 2006

Nancy,

Your insurance should cover all of your pre-op testing. I did all of my pre-op testing through AETNA and then they wouldn't pay for surgery so I'm going to Mexico. I'm also an RN so although I know Mexico sounds scary it was no scarier than when I went to Temple Hosp and the Dr told me that they have done a couple of dozen bands. Your Dr should give you a script and then just schedule all of your pre-ops, they'll use obesity or GERD as a billing diagnosis. Question the Dr also, my surgeon in the states only required a colonoscopy if you are over 50. If your O2 Levels are fine maybe they won't require ICU. Good Luck and keep trudging through.

Elisabethsew · August 8, 2006

Not always correct!! I have severe sleep apnea. I spent the night in a regular hospital room not hooked up to anything. I was never required to have a colonoscopy (never heard of one being required). I have many medical problems including having had open heart surgery, so if anyone should have had to be followed closely it would have been me. I had great care, but certainly just stayed the night and went home, not hooked up to anything. I needed clearance from my cardiologist, an EKG, thallium scan, psych eval, letter from PCP, sleep apnea study and a couple other things, but certainly have never heard of anyone with sleep apnea having to spend the night or 2 nights (eek Gods) in ICU. That is beyond belief. Please don't speak for all of this, as I wasn't required to do most of this stuff, and many people are not. I also wasn't required to have an endoscopy. It was never, ever mentioned. I had a top surgeon at Vanderbilt and never had one bit of a problem. Sounds like money gouging to me. Find another surgeon.

Dody,

If you read my response carefully, I said MOST not ALL people have the tests that were asked about. I most certainly would never speak for you.

Thank you,

JMO · August 8, 2006

nancy,

I too was overwelmed by all the little EXTRA's when it came to the lap band... 1st thing to do is find out what your max out of pocket is through your ins. company . I also have a 90% coverage and my max out of pocket is 650.00 per year. So all thoses test should be included in that. Also don't for get when the hospital calls you to confirm your surgery, they will tell you how much money to bring. If you don't have that much tell them what you can bring. Hospital bills you can pay monthly....

Next make sure your doc does not charge a participation fee. Mine did and told me last min. that I was going to need 500.00 just for him before the surgery. So check on that.

And lastly don't freak out, with my out of pocket and participation fee I was only out 1400.00. ( I also had to have Gall Bladder surgery too) Thats right about 10% of the surgery itself. LOL Good luck and I am sure you must have a max. out of pocket so check on that and relax!!!

VelvetKiss · August 8, 2006

I had alot of pre op test too and if you have your Primary PCP order them your insurance should cover them just like any other testing. I was told I would need to spend 1 night in ICU but I did not have too, so I would say it will depend on how well you do during surgery. Also check with the hospital your going to be using and see if they have a program that may help you pay the up front costs, the one I used had a program for people who needed some help to cover what insurance didnt or if they didnt have insurance at all, so it cant hurt to ask them if they can do anything for you or maybe they can bill you and set you up on payments to lower your out of pocket expense. Good Luck!