midwest bariatric, self pay vs. 6 month insurance wait??

Hi everyone! I'm really glad I found this site. So I've been struggling with losing weight for most of my life, I'm almost 26 and have been overweight since probably around 3rd grade! AGH! I, just like probably everyone else, have tried and failed so many diets....I'm finally fed up even more than I've ever been fed up. I don't know what to do. So i'm looking into the lap band..i'm not sure I like the major surgery part of the actual bypass. I'm afraid of complications. I've been reading everyone's struggles with insurance and I just don't want to deal with 6-7-12 months of 'hoping and dealing' with the long list of things they want to qualify. I've been hoping and dealing most my life that I'll step on the scale and be a few pounds lighter..and yes I've exercised and tried the healthy..and not so healthy ways of losing weight and still end up in the same place. I sooo enjoy going to the gym, but when I wake up and am stiff and sore and tired, i don't want to go to the gym, I don't want to eat good, all I want is to be able to have an extra boost to help me lose weight to feel good. ANYWAYS...my question is...How many people say 'forget it' and self pay?? I'm very tempted to do that if I decide this is what I want to do. It's hard enough to be overweight but knowing in 6 months I could still be fighting with appointments and insurance or actually be losing weight??? Any suggestions? Also, to those who went to midwest bariatric at theda clark..how was your experience...I'm sorta scared to try this. My parents are supportive and actually my mom brought it up that she saw a commercial for the lap band. Thanks for listening

Hi Marie, I'm not sure about the cost of a Lap-Band I would think it would be a little less because it is less evasive than opening you up., I have had a Vertical band done 5 years ago in WI. and the hospital cost alone was almost $30,000.00. That is not counting the doctor or the anesthesiologist, pre-test, and aftercare and god forbid any unforeseen problems that may occur. I know waiting for the insurance is a pain but at least then you are covered just in case. I don't see too many self payers in the forums that I go in. For whatever its worth that's my two cents, Good luck with everything. Take Care, Sandi

I had considered going the self-pay route when my previous insurance had a WLS exclusion. I decided against it when I realized that it is not just the surgery that I'd have to pay for, but any follow up visits, treatment for complications, etc. While it was most likely that I would have surgery and not have any complications, there was a very real possibility that I would have some sort of complication that would result in a longer hospital stay, additional medical care, etc. That is the part that worried me. I knew I would quickly get in over my head financially if I didn't have insurance that would cover not only the actual surgery, but any possible "what ifs" that also could occur. It is NOT fun to jump through all the insurance hoops, but I really do believe financially it is the best bet. Six months seems like forever, I know, but in the scheme of things, it is really a very short period of time. Good luck!

Here is my .02 cents worth. I was lucky that my insurance company that I currently have didn't come out w/the 6 mo wait till AFTER my surgery. However, it was no walk in the park and I struggled to get approval. There are complications to any surgery. Given that WLS is done on those of us who are already comprimised because of one health reason or another - there is the risk of having complications. I recently had a hysterctomy - there were just as many "risks" as when I had my Gastric Bypaass 2 yrs ago. One is more invasive than the other. One is going to give you quickier results than the other. It will be "easier" to cheat w/the Lap Band vs RNY. The pros and cons to both are very much equal in my book. If you ask myself (who had RNY) I'm going to be pro RNY. If you ask Jennifer Gail who had surgery w/the same surgeon(s) I did she will be pro lap band. Why..because that was what was "best" for myself and for her. Now - on the the self pay vs the insurance approval. If you have ANY surgery with out insurance approval AND self pay. You will 99.99% NEVER BE ABLE TO GET "that" insurance company or ANOTHER to pay for ANY follow up appts. Plain cut simple and dried. I know to many people that are self pay. Their surgical group told them that their follow up appts would be covered, ect ect - and it wasn't. Nothing, Nadda..not a dime. Take myself as an example. I had RNY - insurance paid. While in the hospital I had a cathedar (as does anyone who has surgery) I ended up struggling for 3 months with UTI infections as a direct result from having a surgery that was covered my insurance. If I would have not had insurance coverage my insurance would have denied (or could have) any follow up care for that. Then I struggle w/anemia. I have had to have iron transfusions on a weekly basis and would have went to 2 x's per week ($300 per time) and then that led to having a hysterectomy. Theoredically (sp??) this could have ALL been related to my WLS and nothing covered under my insurance. I was told by my hemotologist yesterday that I will most likely have to have iron transfusions periodically for the rest of my life. What I'm saying is - if you self pay (at least in WI) you are taking a risk of not being able to get insurance to cover you for the rest of your life. It is a big risk. Please remember this is just my thoughts and experience from people that I know - that have not only had WLS but plastic surgery and other surgeries and then end up paying for the out of pocket expenses that were not "expected". A plastic surgery that was supposed to be in and out and no unforseen complications. Ended up with having severe bleeding due to large varicous veins ect ect. Few days in the hospital and 2-3 follow up surgeries - all unpaid. The plastic surgery was medically needed but the insurance co. didn't think so. Just some food for thought and my opinions! Good luck on your choices. Gala

i dont know if this well hel*****t i am having rny, but my insurance required the 6mo supervised diet, and it went by faster than i could have imagined, my papers were submitted and i was approved the day after, and surgery was schedualled about 2 1/2 weeks after on nov 13th, so i had absolutely no problems! I dont have your same insurance, i have security health, but i think that it is at least a good idea to try to get insurance to pay i had no problems, but i know that every insurance company is different as well! GOOD LUCK in whatever you decide to do, just keep in mind that if this is something that you are meant to do it will happen one way or another!

Thanks for your answers. I know it would be better if my insurance pays...and I know this is a "lifestyle" change not a short term diet like someone wrote. I feel like I eat fairly healthy..don't go out to dinner much..rarely hit fast food places..and I do exercise and lift weights...and the weight just won't budge! Anyway, Lisa E..congratulations and...so you just followed the required nutritionist, psych, and 6 month diet and approved? I think it's hard cuz you think to yourself..if i'd thought this up 6 months ago I'd be at the end..and now it's another 6 months. So that rule is disappointing. Thanks again for the input.

yup basically that is what i did, followed the 6mo thing, did the physc eval and when i was done i seen the dr one more time, and a week after that i was apporved, i guess i would say at least give going through insurance a try if you get denied or whatever then you can look into self pay, but that is just how i would look at it , so good luck in whatever you decide

I am one of those few patients you'll find that went the self pay route. But I chose to proceed after I tried with insurance. However I didn't have to wait 6 months because there was a direct exclusion in my policy and the likelihood of it being overturned was slim to none, so I decided to self-pay. I do not regret my decision for a minute. This is the most successful I have ever been in losing weight (85 lbs in 6 months, hope to lose 30 more). I was able to schedule the surgery when I wanted (jumped ahead of the line, if you will). I compare the cost to that of buying an expensive car--and aren't you worth that much? Yes, you are taking some risks with complicatons. I was fortunate to have had smooth sailing. While my surgery was not covered at all, fortunately all my office visits (pre- and post-op) have been. (I know, it makes no sense). Each company is obviously very different so you'd have to do a little investigating. I cannot give you any feedback about the medical center you are looking into. I did check into several places before selecting Dr. Wallace at Froedtert Hospital. I believe it is the best program around here. My total out of pocket cost for the hospital stay was about $35,000, which I took out a personal loan for. But for that amount I got back my life! I look and feel better than I have in 10 years.

christina, thanks for the input. That's really nice that the pre-op and post op appts were covered. I called my insurance today and they're going to send me what is all required. Lots...but seems normal..nutritionist, psych, 6month physician followed diet, exercise therapist, documentation of obese for 3 years...it's a lot to take in. I'm gonna call my regular doctor too,

Marie, Sorry to being replying so late in the game but I haven't been checking in laterly. I had RNY surgery on July 25, down 86lbs. Dr. Wasco was my primary and Dr. Georgen was the assistant doctor. MWB is great, everyone is so helpful and everytime I call with the simpliest questions I get answers right away. Once I had an appointment and Dr. Wasco called me personally at work to see if I could come in an hour earlier. Never have I had a doctor call me for anything. I was one of the lucky ones that insurance approved me within a couple days. I had a lot of hoops to jump thru but MWB made sure all my ducks were in a row. I receive copies of what my insurance company pays, I'm not sure of what the final bill is but I know that 2 of them where for over $11,000 each. Feel free to e-mail me if you want. Missy