If self-pay and then complications, who pays?

April 26, 2005

What if you are a self-pay in the U.S. for the surgery and then you have a complication, like infection or stroke or whatever. Does anyone know if the insurance will cover? I need to call my insurance to clarify this.

MemphisLady · April 26, 2005

I am so glad you asked this. I had to look to see if I posted this question. It has been on my mind for a month. I am afraid something would happen and all my old age savings would be gone. I will also be following this thread. Hope we get some feedback! Let me know what your insurance company says.

hagerteresa · April 26, 2005

Hello,

I called my insurance twice before being banded about this exact question. I was a self pay and went to Mexico but MY insurance company said they would pay for any complications both times I talked to them. I am pretty sure they would have to anyway but definitely call and check with your own company. My port is kind of twisted and requires flouro used every time I need a fill. My insurance company even said they would cover the flouro cost because it is a complication from not being able to get a fill without it. Best of luck, Teresa

Alexandra · April 26, 2005

As a general rule, if you have complications that require medical attention, your insurer will have to cover that attention in accordance with your contract. If you got a tattoo that became infected, or had a hair-dye accident or something, the medical issues become something separate than the initial procedure and are handled differently. The fact that that initial surgery wasn't covered is irrelevant, as long as the complications aren't the same day or week. If you're discharged from the hospital then the next medical claim is a clean slate as far as coverage goes.

That said, it's always a good idea to call your own insurance carrier to see what their rules are. And then call your state department of insurance and see if THEY have any rules that supercede those of your carrier. Your insurer might want to say that they exclude anything that is a result of medical procedures they didn't cover in the first place, but your state may not allow that. But in my experience as a health insurance broker, the general rule applies. (Every carrier will ALWAYS say they can't predict with any accuracy until they see an actual claim.)

Penni60 · April 27, 2005

I was self pay and went to Mexico. I developed a complication that required a second surgery. I had it here in the states by a US surgeon. My insurance covered the procedure and is covering most of my fills and doctor visits as well.

DeLarla · April 27, 2005

I've been lucky to some extent. My insurance covered a lot of my complications. I'm still stuck with several thousand in co-payments, but I could have been stuck with $30,000.

Think "the squeaky wheel gets the oil." What I mean is to bark up your original surgeon's tree long enough and they might agree to help you out financially if you have complications by giving you reduced rates to some extent.

princess_n_thep · April 27, 2005

Has anyone had complications with a Mexico surgery and went back to Mexico? IF SO, were you charged over again? Did your original surgeon take care of the problem? Was the problem taken care of? How much did it cost you? (ha ha, I bet lisa is jumping up and down in her seat!)