Newbie with questions

Hi everyone...I live in the Reading PA area and am considering the lapband...My insurance will NOT cover any of it...so I am weighing my options...I went to the seminar and have since spoken with the staff at the Reading Hospital's weight loss center....It will cost be between 15,000 and 17,000 for the surgery....After reading these forums, I have spoken with other self payers who have gone to Mexico for their surgery....Lapband is 5,900 versus 17.000.....my question is, if I do this over there, will the local doctors at  the weight loss center here in Reading  be willing to do the fills?  I have heard that some do and some will not...Any experience in this area would be greatly appreciated!!  THANKS....Jenny

Will your insurance cover other forms of WLS?  Or it done at another hospital etc...?

I honestly don't know....While I was at the seminar my particular insurance was listed as one of the ones that do not cover weight loss surgery...They didnt specify any particular type of surgery...just weight loss surgery in general....and when reviewing my coverage booklet...it was not listed at all as something that was covered...So.....It looks like I will be paying for this myself!!  UGH!

Maybe you can appeal the coverage if your doctor points out all the health issues you have now because of your weight and how much in the long run your insurance co. will dole out (say if you have diabetes - meds, check ups, problems, possible eye, foot, organ issues) - it would be better for the company to pay for the surgery and not have those issues down the line.

Before taking any concrete steps to go to Mexico, I would call a couple of local bariatric specialists and ask them if they accept patients who had their surgery elsewhere.

And yes, I think it will make a difference if you had surgery in Mexico vs. if you were calling because you had just moved into the area for a new job.

Post op care is essential, regardless of what type of surgery you are looking at. Part of your preparation will be making sure that post op care is in place. I'd also check the rates of the post op visits, fills, etc. - part of that cost may be why you see the cost difference up front.

Best of luck to you and be sure to let us know what you decide!

Thanks for the responses...Actually the hospital in MExico includes fills for a year....Where the local doc here only includes fills for 3 months....THe cost of the fills is 116 dollars here....I will need to find out if they will be willing to do the fills for me even though I went out of the country for the surgery....Thanks again!

Do you have medical problems?  Perhaps, your insurance would cover the surgery if there is a medical need.

Hi Jenny,

I am not really sure about the fills BUT I had lap band surgery last week (5/20/10) and I was in your same situation.  I chose to have my surgery in Pennsylvania and I ended up paying for it myself.  If you do choose to have surgery in PA, I want to share some things that I learned.  

Please remember that I was unsuccessful in every step but I do not regret trying.  You might have have success where I did not!  Here are a few steps I took: 

(1) Called my private health insurance and asked them a million questions and kept running by scenarios to see if there was any way to get coverage. 
(2) Asked my private health insurance how to formally be denied so that I could officially appeal it.  You need to be denied in writing in order to preserve your appeal rights. 
(3) Asked if there was any way I could purchase a rider (sp?) for my insurance coverage.  I heard rumors that sometimes you can do that for procedures not covered and it is cheaper to pay for the rider than for the actual surgery. 
(4) Called my human resources director and asked if there was any way to make an exception.  I have heard stories that human resources can intervene.  However, mine had never heard of that sort of request.
(5) Asked the doctor and hospital in advance what pricing plans they had available for self-pays. 
(6) Discussed with my doctor all of my symptoms so that every relevant symptom could be included in specific pre-op referrals.  For example, if your doctor only lists you as having morbid obesity, your insurance might not cover your sleep study.  However, for example, if you snore, have restless sleep, and restless leg syndrome, you will probably be covered so you should be candid with your doctor.   I called my health insurance company about each specific test to make sure that it could be covered.  I then discussed my relevant symptoms for each specific study with my surgeon and ultimately I was covered for all pre-op consults and tests. 
(7) Picked my top choice doctor at my top choice hospital and asked that since I was a self pay that he personally do the surgery (i.e. not the residents) and he agreed. 
(8) Although I just paid in full, you may want to ask about payment plans.  After all, each hospital has bill collections departments because some patients cannot pay and I would think that they had plans in place for people who can pay but want to space it out. 
(9) Ask for a personal meeting for the person in charge of billing for the hospital.  Talk to that person and just have them tell you all of your options. 
(10) Ask for an itemized bill.  I still have not received one and I am going to continue to push the issue.  All I received was a verbal number (never in writing) which I had to pay.  Also, they made me pay for four days even though I was only there for one night. 
(11) Talk to your accountant because if you do the self pay and it is over a certain percentage of your income, you can get some sort of deduction on your 2010 income tax.  Check to see if surgery in Mexico qualifies.  Save all of your receipts (including copays, parking, medications, etc.).

Good luck with whatever you choose!!!
Christine

wow that sounds a little bit like WORK!  Whew...I am tired now just reading it!  LOL....Was your pre-op testing through your primary care doctor, or the lap band doctor...?  My primary care doctor is VERY conservative...Im not sure he would even approve of the surgery in the first place...He wont even give my 19 year old son adderall for his ADD which he has had since childhood....so...I can only imagine he wont be supportive when he hears of this plan....not sure though...I havent  talked to him yet....we'll see....Thanks for the info...I will deffinitly be trying some of your steps

Hi Jenny,

You are right that the process is exhausting!  I think what made it particularly draining for me is that I did eveything in a period of only a couple of months.  However, I am now six days post-op and I am really happy with my decision and have no regrets. 

I have a PPO so I do not have to go through a primary for referrals for specialists.  My surgeon just filled out all of of the orders for tests and consults.  My first visit with him was covered and I just paid a co-pay. 

Even though it was not necessary I actually tried to see my primary care physician just to talk about my health, weight management, and plans for the surgery and she was not entirely supportive so I skipped over her.  When I am sick she is a wonderful and compassionate doctor so it was a little surprising that she was ambivalent about my surgery.  So just know that you are not alone in your predicament! 

Maybe your first step is to research doctors in your area that focus on weight and eating disorders and then ask for a referral to someone who can help you with your weight management.  Then you can talk to that doctor about your goals and hopes for surgery and he/she can reach out to your primary and/or refer you to a surgeon.  

When you have your first in-office consultation with your surgeon he/she will examine you and tell you what tests and consults you need.  Not everyone needs everything.  Then maybe your weight/eating disorders physician can order those tests for you so they are covered by your insurance. 

As far as your son goes, could you ask your primary for a referral to a psychiatrist?  I think psychiatrists routinely treat people with ADD. 

I hope this helps a little.  Please feel free to write to me if you have any other questions! 
Christine