Self Pay Banding

Longhorn · October 21, 2007

I'm paying $12000 for the surgeon, hospital, anesthesiologist, and one year of after care, including free fills. In addition, it's $250 for the initial consultation, $150 for the psych eval, $75 for the nutritionist visit, plus labs, some of which may be covered by my insurance.

I considered going to Dr. K in Denver where my daughter lives but was concerned about the convenience of flying to Denver for after-care. Same concern with going to Mexico and even down to San Antonio, 90 miles away. I'm an adjunct faculty and hourly tutor so I get no sick leave and can't miss classes. Also my schedule changes every semester. For me, it's better to stay local where I can fit an appointment in here and there without missing work.

kacee · October 21, 2007

Did any of you who self paid ever get approved and tried to get the money back from the insurance company?:omg:

You and I are thinking along the same lines, kiddo. I thought about that too, and asked around and people mainly said they doubted that once the deal was done you could recoup your losses. After all the angst that people have gone through to get their insurance to approve and sometimes over a year or more in which to do it....at 55 I said SCREW THIS. I don't have the time to lolly-gag around for some paper pusher to inform me of how the rest of my life is going to go. I am GLAD I self-paid. All the grief and aggravation was completely off me and all I had to do was concentrate on the surgery and recovery and getting on track. If I hadn't, I'd still be messing around with some medical program and praying that when I went back to Cigna in December that they'd give me a green light (NOT).

Longhorn · October 21, 2007

You and I are thinking along the same lines, kiddo. I thought about that too, and asked around and people mainly said they doubted that once the deal was done you could recoup your losses. After all the angst that people have gone through to get their insurance to approve and sometimes over a year or more in which to do it....at 55 I said SCREW THIS. I don't have the time to lolly-gag around for some paper pusher to inform me of how the rest of my life is going to go. I am GLAD I self-paid. All the grief and aggravation was completely off me and all I had to do was concentrate on the surgery and recovery and getting on track. If I hadn't, I'd still be messing around with some medical program and praying that when I went back to Cigna in December that they'd give me a green light (NOT).

I was kind of relieved when I found out that my insurance doesn't cover WLS at all. Like you, I didn't want to have to prove my need to anyone. The only "approval" I needed was from my husband of 31 years and he didn't hesitate a bit as far as the money. He loves me no matter what but he knows how tired I am all the time and how I want to look and feel better. Although I've been considering this off and on for several months, the first I mentioned it to my family was on September 21. And here I am a month later with surgery scheduled in just 11 days! :clap2:

TeTe2 · October 21, 2007

I am a self pay. My insurance (Aetna Select) has any type of weight loss treatment as an exclusion.

We have two local hospitals that do Lap Band surgery both hospitals use the same group of bariatric surgeons.

The Surgeon fee is $6K, covers all fills for 1st year then $250 ea.

Hospital A (Christiana) : cost $17,500.00 pre-op classes & nutrition classes & support groups not included.

Hospital B (St Francis) : cost $11,500.00 all classes & support groups included.

Insurance covered the req Pulm & Cardio drs appt & the req tests the ordered (ex sleep study. stress test, echo, etc)

I also found out self payers do not have such ridgid requirements to qualify for surgery, such as # of required nutrition classes, support sessions etc. So self paying actually worked in my favor. I had only 3 req nutrition classes & 3 req support group meeting that I had to attend, with no begining weight loss requirement. If I would/could have gone through my Aetna insurance I would have been req to attend an additional 12 classes with a begining 10% weight loss requirement. Adding an additonal 2 mos wait.

So I drained fmy 401k and I am currently just waiting for my surgery date.

Call around - every place is different. Good luck to you.