Insurance thoughts

The scenario where my insurance refuses to cover anything even tangentially related to VSG has kept me from seeing anyone yet for my GERD and potential gallbladder attack. I would ask for my treatments and visits to be billed as unrelated to VSG but it is such a huge financial gamble to make. I could be financially ruined for life and my family along with me!

I have three autoimmune conditions, require joint replacements, and have lymphedema and likely lipedema. I've had four abdominal surgeries and am about to have my 2nd WLS. I completely get it. I will never have insurance if things change, if I do not work for a major corporation.

Having said that, you need to see someone for your GERD ASAP, because GERD can be potentially fatal if it causes damage over time. Cancer is far more financially ruining.

I am worried too, Mahonia. We both have to live in the present, though, and in the present we are still safe for now, and we must get the care we need to survive. I know it is terrifying, very much so. I also know that you deserve to get the health care that your family pays for, because if you have insurance you are already paying for it.

I was self paid for WLS. But I had mine on USA. Still, I had elective surgery for medical condition. Even if I wanted my insurance to pay for it, my insurance did not cover any WLS procedure.

I had hernia surgery, a few, GB removal, and I deal with GERD.

All of those issues can happen with or without RNY. And no doc will put the cause of the GB failure as RNY. It was due to rapid weight loss that could happen regardless of RNY. Same with hernia. Some with my blood work.

Most of my lab work is covered by insurance. All my surgeries - hernia, GB removal and cut scans, etc., was covered by my insurance.

Most likely my RNY contributed to some of my conditions, but my condition could have been an underlying reason for me getting obese in the first place.

It is a chicken and egg dilemma.

Finding a doc who properly codes the procedures to make sure the insurance will cover it. Most docs understand the issues. If a doc does not get it I ask him "so you are saying that I could not get ABC if I did not have my WLS? So far not one doc can give me a 100% that some of my issues are exclusive to my RNY.

Since I had been my surgery in US, even self paid, I list it, plus my PS elective/ reconstructive surgeries, on any medical forms.

If your insurance company rule is one weight loss surgery per lifetime, no matter who paid for it, then you are committing insurance fraud if you get them to pay for another weight loss surgery by withholding information.

If they pay and then find out about your previous surgery, then they can come back on you for the money.

The surgeon performs a revision is going to document that you had VSG when he does your surgery. Because it is different to convert VSG to RNy than to do a virgin RNY.

As long as you are not buying new insurance or not having additional weight loss surgery, then you do not have to contact the insurance company tor report the VSG. If you experience complications from the VSG, you could have issues with getting your insurance to pay for them.

Policies that do not pay for weight loss surgery also do not usually pay for complications of weight loss surgery.

If the affordable care act is repealed or changed, it is very likely that pre-existing conditions will once again be charged at higher rates. If part of a large group, it will probably not be an issue, but once you have had weight loss surgery, that will always be a pre-existing condition.

We also must accurately document. We can't neglect unique anatomy. It's a huge liability issue from a legal standpoint. However, it's a huge safety issue for us as patients too. Though a sleeve does not have the issues a pouch does, it absolutely alters our bodies permanently in ways doctors need to know about it.

It's a huge safety issue to not tell doctors about WLS, especially if you are having other surgery.

I think any insurance that you get will want to know about any surgery that you've had, even if it's out of the country. If you want to get treated say a complication or something else that came out of your surgery they might deny you if you never told them about the surgery.

Even worse, they pay, then take back the money they paid for treatment & the hospital/Dr comes after you for payment.

The scenario where insurance refuses to pay and I'm destroyed financially for life is why I haven't made an appointment with a gastroenterologist yet for my GERD and probable gallbladder attack. The US healthcare system is beyond ridiculous.

I'm not trying to scare you or be an ass, but you are gambling with your life.

Gallbladders can rupture and cause an infection of the blood stream.

GERDs leads to barrettes esophagus which in turn leads to throat cancer. So you have two choices either do nothing and possibly die or get to a doctor to fix the issues and deal with some medical bills. I personally would rather have medical bills than die.

I understand you went to Mexico and was self-pay is that because your insurance doesn't cover WLS?

My BMI was 38 when I had VSG and my only comorbidity was PCOS. I would have had to gain 11 pounds to get to a BMI of 40 and maintain that for two years and then go on a 3 month supervised diet and not lose anything in order to have my insurance cover it - and even then my out of pocket costs would be almost as much as paying for the surgery in Mexico.

OK...I get the whole "financially ruined" thing..BTDT..and survived...came out a better person, for it, even...

Now...as a 28 year Mama, and 40 year career nurse:

What's more important? Your credit rating or your life?

Screw pre-existing. I would tell any and every medical professional I confer with every procedure I've had. It's not like the sonograms, etc aren't going to show you have surgically altered guts...

I know you asked, specifically about INSURANCE, but you had so many great responses (especially DONNA and WHITE DOVE), that you didn't need any "ditto", from me, on that front

In case of emergency, especially, I REALLY think the VSG needs to be part of your medical record