Self Pay & Complications

[MamaK 0]

I am seriously considering VSG. Already consulted with one Dr. and checking out another next week. My question is, I am self-pay. Insurance will not cover any WLS. I'm scared to death of complications and medical debt that could ruin my family financially. The first Dr. has an insurance plan (Blis) that they make you take out that covers complications for 90 days after the surgery. In talking with the second Dr's office, they claim complications should be paid by insurance as they would have a different medical diagnosis. Can anyone out there who has had the unfortunately experience of complications and been self-pay tell me how that went for you? Your experiences are much appreciated!

[NORCALRN 60]

I am seriously considering VSG. Already consulted with one Dr. and checking out another next week. My question is, I am self-pay. Insurance will not cover any WLS. I'm scared to death of complications and medical debt that could ruin my family financially. The first Dr. has an insurance plan (Blis) that they make you take out that covers complications for 90 days after the surgery. In talking with the second Dr's office, they claim complications should be paid by insurance as they would have a different medical diagnosis. Can anyone out there who has had the unfortunately experience of complications and been self-pay tell me how that went for you? Your experiences are much appreciated!

i had my sleeve in mexico7-24-12 home and 10 days later or so severe complications (7 weeks in the hospital and still wit a j tube (feeding tube). i have kaiser - live 30 minutes north of the golden gate bridge...KAISER WAS EXCELLENT! MULTIPLE ambulance transports, surgeries, home health care - i paid zero! i am sure laws differ state to state, but if you are an emergent patient, it is illegal to deny care. good luck with your decision. even with problem, i am standing here smiling happy with my choices!!!

[notime 340]

It depends on the insurance company and the specific policy you have. Call your insurance company and ask them. Also ask if there is a specific portion of your policy that addresses your situation. If so ask what the section/s is/are. If your insurance policy guidelines are online, look up that section and check it out. If it is not online, request that they send you the relevant section/s and then check it out. Good luck.

[Taminski 20]

I too am self pay as I don't qualify for surgery through my insurance even though they cover the procedure. Per the conversation I had with them since they didn't pay for and cover the surgery they will NOT pay for any complications or aftercare related to it. That means if I have complications I am on my own. Need to get my Vitamin levels checked, again on my own. They will benefit down the road from my having the surgery and getting healthy but won't pay anything towards it. However I really feel like I need to do this. No I don't want to cause a financial hardship on my family and I am praying that there will be no complications but I can't go on like I am now either. So I'm taking the risk, on my own.

[No game 14,436]

I too am self pay as I don't qualify for surgery through my insurance even though they cover the procedure. Per the conversation I had with them since they didn't pay for and cover the surgery they will NOT pay for any complications or aftercare related to it. That means if I have complications I am on my own. Need to get my Vitamin levels checked' date=' again on my own. They will benefit down the road from my having the surgery and getting healthy but won't pay anything towards it. However I really feel like I need to do this. No I don't want to cause a financial hardship on my family and I am praying that there will be no complications but I can't go on like I am now either. So I'm taking the risk, on my own.[/quote']

May I ask why they won't cover you?

[leanerlena 6]

My insurance won't cover me because my employer has an "exclusion clause" for weight loss surgery. There is no way around an "exclusion clause". Any complications directly to the surgery will not be covered. However, if there is an issue after surgery not caused by the surgery then that's a different story. Example, if I become dehydrated and need to visit the ER, I am visiting the ER for dehydration and will be covered. I am very confident in my doctor and am not looking for any complications. There's no room for fear - just faith

[MamaK 0]

Insurance has an "exclusion" for WLS. BOO!!!

[EMSJen 6]

I was self pay and 3 weeks post op complications began. I have an individual plan thru bcbs (bought directly thru their website). It didn't cover WLS but has covered all my complications... about 3 months in the hosp, 3 ICU stays... 3 more surgeries including a sleeve to bypass (reconstruction). My plan was a temp plan that expired while I was in icu the first time... luckily a friend found a claus that said if it expires while ur in the hosp you get a 90 day ext. If you don't have insurance look into a temp plan to cover you for at least the first 3 months. I would have over a million dollars in medical bills I'd I didn't have mine!

[TxCalico 69]

Insurance companies love to find any reason to exclude coverages... so check the fine print carefully. When you self-pay, it is similar to getting cosmetic surgery (like an eye-lift); you pay for the surgery, and you pay for any related complications.

I'm considering getting the sleeve and it will be self-pay, so I'd love to know more about the short-term coverage. Maybe I can google BLIS...

[Taminski 20]

May I ask why they won't cover you?

My insurance requires 5 years of documented weight over a BMI of 40 in addition to 3-6 months supervised diet and other clauses if you don't have comorbidities. I have been overweight forever but I don't go to the doctor much and have usually been around a BMI of 38-39 or lower when on one of the many diets I have done. Since I don't have comorbidities I don't want to wait another 4 years for documented weight over 40 BMI or for comorbidities to develop so I am moving ahead on my own.

[DrPleatman 3]

As a surgeon who takes care of many self-pay patients, I will tell you that I also fear complications. It is bad enough when one of my patients has a complication, but it is worse when that complication may bankrupt them. Fortunately complications are rare, so it isn't often a problem. It is also fortunate that many insurance companies that don't cover WLS will cover the cost of complications. BLIS is also a reasonable program, though I will admit that I don't use it because it is expensive and they require you to use them for ALL patients... it will raise the cost of the operation by more than $1000.

Ultimately it's just another factor you have to consider when deciding to have bariatric surgery. Do your research and find a surgeon you feel comfortable with.

[Tammy Meyers 5]

I called my insurance company. They told me as long as I was released for the surgery center and had to go to the ER I was cover.

Call your insurance.

[fancytiddy 5]

i had my sleeve in mexico7-24-12 home and 10 days later or so severe complications (7 weeks in the hospital and still wit a j tube (feeding tube). i have kaiser - live 30 minutes north of the golden gate bridge...KAISER WAS EXCELLENT! MULTIPLE ambulance transports, surgeries, home health care - i paid zero! i am sure laws differ state to state, but if you are an emergent patient, it is illegal to deny care. good luck with your decision. even with problem, i am standing here smiling happy with my choices!!! <img src='http://www.bariatricpal.com/public/style_emoticons/<#EMO_DIR#>/smile.png' class='bbc_emoticon' alt=':)' />

If you had kaiser why did you self pay and not go through insurance for your WLS?

[McButterpants 2,846]

My insurance won't cover me because my employer has an "exclusion clause" for weight loss surgery. There is no way around an "exclusion clause". Any complications directly to the surgery will not be covered. However, if there is an issue after surgery not caused by the surgery then that's a different story. Example, if I become dehydrated and need to visit the ER, I am visiting the ER for dehydration and will be covered. I am very confident in my doctor and am not looking for any complications. There's no room for fear - just faith

This is spot on with what my insurance carrier said to me, too.

For those that are self-pay - if you are going to a doctor for follow-up aftercare and you're insurance doesn't cover weight loss, your aftercare probably won't be covered either. My follow up visits with a local bariatric surgeon & nutritionist is $185 per visit - visits are scheduled at 2 weeks, 6 weeks, 12 weeks, 6 months, then yearly; that adds up (a little under $1000 the first year) and something for which I didn't necessarily budget. I believe the aftercare is important and I go to my visits with a local bariatric doctor as I would had I been her patient.

[sbarbiegirl 109]

I have my surgery in Mexico. My pcp does my follow up care. Really all she did was look at my cuts and routine bloodwork every 3 months. My insurance did cover it. I have only had to pay my normal co pay.