Perforation after self pay

I had a VSG to DS revision on 12/10/15 with Mexicali Bariatric Surgery. Cruising along just fine until now, 6 months later. 2 weeks ago I went to the ER with the worst pain of my life and ended up being diagnosed with a bowel perforation and had emergency surgery performed that night. I was inpatient in the hospital for just under 2 weeks. 

I am terrified my insurance won't cover any of this because it was a complication of something I did on my own down in Mexico. 

I was looking through my history of claims and they denied the ER visit I had later in December 2015 for general abd pain/incision issues--wanted CT to make sure no leaks. I have yet to receive that $9,996 bill so I wasn't aware it had been denied. 

Does anyone have any experience with complications in the US after self pay surgeries? 

I was self pay with Dr. Greenbaum. He told me that insurance will generally pay for complications starting 30 days out. 

I was self pay at the Cleveland Clinic.  They had me buy supplemental insurance for the first 90 days post-op. They felt any problems after that would be covered by my insurance as they considered by that time not directly post-op related. I hope you don't have a problem. This doesn't really sound DS related - not like the incision issues.

Pete

Hey Pete.  Where did you find supplemental health insurance? I'm in that exact same boat, and my insurance has said outright (even in an email) that not only do I have zero bariatric surgery, they will not pay for anything that is a complication of an unauthorized procedure.  I'm trying to cover my backside, and not leave my family vulnerable to financial ruin if something should go wrong.

I'll try and find the name. It was a requirement from the Clinic for the first 90 days post-op and they rolled it into the up-front cost so all I really needed to do was sign and they would have taken care of any billing that first 90 days.

Pete

thank you for trying to find that :-)

I hate the insurance industry! I had to self-pay for the DS in 2002, but that was in the US. A few years later I had a bowel obstruction from scar tissue and insurance covered that. If you haven't exceeded the time limit, I hope you appeal on your December denial! Would you mind saying who your Mexican surgeon was? I am considering a sleeve revision there.

This can be tricky, even if they denied the claim were you still charged for it? check your EOB and see if it has been billed to you. I have a weird insurance, because I work for a hospital anything I do in the hospital as far as lab work and other services  goes they will get "denied" but written off because I get it done at the hospital. You may have waited too long to appeal the denial if they have billed you anything since this was back in December I think the only insurance with 180 day claim limit is Medicaid maybe Medicare. You might be in luck sometimes ER visits aren't always billed to the patient even if denied.

6 months?  How do you know it's a complication of your DS?  You are 6 months postop and that's not likely.

The total bill was 79k. So far, the "member responsibility" is listed as ~1800 or so. During the bowel resection, they also took my appendix because it was inflamed. So really, for argumentative purposes, the problem could have stemmed from that (although the surgeon said the perforation was directly at the suture line from the DS). 

I don't know about that December ER bill. Should I call them? Or try to stay under the radar?