Complications not covered?

Have any of you had complications from WLS you had out of country that your insurance company would not cover?  I mean serious and very expensive ones?  Do I understand correctly that if you ended up with a bowel obstruction, your insurance would deny payment because you had WLS that was not approved by them.  Wouldn't the costs of something like that be enormous? 
I rarely hear any negative posts, just praise for the surgeons.  I'm hoping that is accurate and I'm not sugar coating the realities for self pay in Mexico or Brazil.

I know I have asked this before..but I didn't get much answers, so here I go again!

Thanks!

Before surgery I emailed my insurance company (Kaiser Permanente) and explained that I was having surgery outside of their plan and wanted to know if they would help me with routine aftercare and/or complications.  They said they would not help me with routine aftercare but they would help with complications...I would just have to go to one of their emergent/urgent care facilities (not my doctor) to begin treatment if I think I was having a WLS complication.   

Long story short...I got it in writing (email) what they would do for me post op. 

Loree

 

I have kaiser, too. I see routine aftercare as preety much blood work, which a doctor should be doing anyway.

So far, my insurance has covered labs. I tried to see a GI doctor in Stockton CA, but have been told by three so far that they won't do my care.

I would like to check into having a revision. My surgeon, although VERY good, is very conservative and created a 2cm stoma, 100cm bypass and 2oz pouch. I should have had a 1cm stoma, 150cm bypassed and 1oz pouch. Thus, I am not losing nearly as much or as quickly as I would like. In fact, my weightloss has stopped. Everything is a struggle now. I don't dump and I am addicted to sugar.

But that is off topic... before going to Mexico, find a doctor here who will work with you and do followup care. Also be sure your insurance will cover the labs and any complications you may experience.

Best of luck,

Jen

Thanks Jen.  good luck with your efforts for a revision.  It sounds like you went through a lot just to have it done inadequately.  What a bummer.  Too bad you can't get your surgeon to revise it for free!  Or at least a reduced rate.  Of course either he will sight that you knew full well going in to things what he was going to do....like it's YOUR job to understand all that!  Or....You would really rather some one ELSE cut you up the next time... What a terrible dilemma to be in.  I am so sorry, I'll be thinking of you!

I didn't think any insurance would knowingly cover expenses from complications due to uncovered WLS. 

Take care!
C

My surgeon is a very good surgeon. He's just conservative. What he did for me would have been adequate for MOST patients. Most patients dump. I have dumped only a handful of times in 8 mos. Mostly because I overdid it with sugar or more commonly for me, DAIRY.

My body is quick healing and quick adjusting. How was he to know that? I had suspected it, but it was my fault for not communicating with him about my concerns.

Lesson learned for me.

I measured my pouch this morning with hot cereal (cream of wheat). I can hold about 5-6 oz before I begin to feel a sensation of being full. I guess it isn't as bad as I thought.

My insurance will cover follow up as long as I meet their requirements for RNY in the first place, which I did.

I'd go to Mexico again... to the same doctor. I had ZERO complications and the best care. In fact, my doctor and I are still in contact. The nurses gave me the treatment of royalty and I had ZERO pain other than the normal stuff where the camera port was, etc.

I want a revision for more malapsorption. I return to my pcp on the 11th to get the results of my labs. We'll see then how good I am absorbing.

Jen

Might I ask why you went to Mexico when your insurance would cover the RNY?  Was there a benefit to you?  Perhaps not waiting?  etc.

Thanks! 

I didn't have this insurance at the time and the insurance I did have, BCBS Anthem, had an exclusion of WLS.

I had the lap band surgery in October 2007 in Mexico with Dr. Ortiz Lagadere, at the Obesity Control Center. I had severe abdominal pain and vomiting after I arrived home on the 3rd, and had to be hospitalized twice: once at my local hospital and then transferred by ambulance to the closed large medical center which is about an hour from my home in Washington state.

The band was eventually removed by a surgeon here who said that it hadn't had any stabilizing sutures placed at all, and was moving around.  I was immediately better after the removal, and went home the next day.  Including the original cost of the surgery ($8,500) I now have over $38,000 in medical bills, NONE of which was covered by my insurance here, as it was related to a "non-covered" procedure.

The OCC is also completely ignoring me now, even after sending them copies of the statement by the surgeon here and the bills.  Most of us know how friendly and solicitous they are before the surgery, but you better hope you don't have ANY complications. I am now in debt, being treated poorly by those who were supposed to be caring for me, and by the way, still overweight because all this was for nothing.

You should also know your legal recourse if there were complications is very limited if you can get anyone to even think about taking your case.....which is why these clinics are in Mexico, of course.  It isn't just for your convenience.

Think carefully and good luck.

Did you mean for me to receive this message? I've already had my procedure in Nov 07. Other than feeling no restriction or dumping, I am fine. If I were to do anything more, it would be the ROSE or clips put into my stoma and shrinking the size of the pouch again. Otherwise I'm doing fine.

Thanks

jen