What if you have complications once you are back in the states.

What if you have your surgery in Mexico then a month later you have complications?

My insurance won't approve the DS or VSG. They only the approve  RNY and Lapband for a BMI under 50, so I am looking at self pay now.

My concern is if I get home and have major complications that need to be dealt with in Minnesota will my insurance cover complications from an unapproved surgery? Also after having jumped through all of the hoops to get a surgery in the states that was then turned down by insurance, will the local clinic take me on as a post-op? Anyone have to deal with this? 

Thanks

HI,

I read your post and thought I'd pass along a few thoughts and maybe some advice.

In most cases, if WLS is listed as an exclusion in your insurance policy, then any complications resulting from the surgery will be excluded as well.  The best thing to do is call your insurance company and ask them.  It really just depends on how the policy is worded .  Just remember to get everything in writing if they should say that complications from a self pay surgery whether in or out of the country will be covered.

I was self pay and I decided to go to Mexico.  I did a lot of research because I knew self pay for surgery meant self pay for any complications as well.  That said, I chose the surgeon whom I felt had the credentials, experience and reputation to offer me the LEAST amount of worry over post op complications.  I've never regretted my decision.

Having a local doctor who will follow you for routine post op care is really important and you should be sure to have that post op provider in place BEFORE you travel for surgery.  Your patient coordinator should discuss this with you without you having to bring it up. They should also help you locate an aftercare provider before you book your surgery.  Don't fall for the promise of them helping you find an aftercare provider AFTER surgery and  when you get back home.  If they don't offer . . . don't ask!  Look elsewhere for a practice willing to go above and beyond for their patients.  You need to be able to trust in and depend on your surgeon and coordinator for help post op as well.   

My best advice is research, ask questions, research, ask more questions and research some more until you feel confident with the surgeon, your coordinator, the staff and the location and hospital where your  surgery will be performed.  *Choose a Board certified bariatric surgeon and a JCI accredited hospital*  If you are not familiar with JCI, you can research it here:

http://www.jointcommission.org/AboutUs/Fact_Sheets/jci_facts .htm 

No surgeon can promise or guarantee that you won't have complications.  Complications are possible with ANY surgery no matter how simple or invasive.  But if you take your time and do your research, your chances of having complications will be much lower.

I hope this helps get you started in the right direction.

BB

Lap Band - 11/05 - minus 130 pounds and
I LOVE MY BAND!!!

Dr. Horacio Guajardo
Monterrey, Mexico
www.drhoracio.com
800-545-8757

                         "To find true happiness in life, you first have to find yourself."

    

Thank you for the great response.

I'm not a doctor, but I do work for a health insurance company, and I don't believe that a stateside claim for complications from a non-covered surgery done outside the US would necessarily not be covered.

Let's say you have surgery on Aug 4 for a non covered DS in Mexico.  You come home a week later and develop a problem.

The hospital who bills your insurance company is going to list your diagnoses not as post WLS but intestinal bleeding, stricture, leak, staple rupture, etc.  Your WLS surgery will be referenced in your admit history but what the claim processor sees is what the hospital bills.

Look at it this way: some employers cover elective abortion and some don't.  But if a woman had an elective AB and suffered a complication requiring follow up treatment, the claims for that treatment would be considered per the plan benefits, just as would a claim for a ruptured appendix, etc.

What I'm saying is not a guarantee of benefits nor a determination of medical necessity ... just the word from someone in the insurance trenches for 17 years.

I knew going in that my policy didn't cover any weightloss surgery.  I didn't think that I would have any complications so I didn't worry.  Unfortunately I did have complications (leak & abcess)  My insurance Co has denied all claims and I am looking at $70000 in medical bills so definately check your policy carefully.

Hi There,
Oh...you poor thing!  How are you doing now?  I have a scheduled surgery with dr. joya on the 17th of August (yikes ...12 days away).  Did you have complications once you got home?
Did you pay the $500 complication fund fee?  Did you do the pre-op diet?  I have a bmi of about 34 and want to lose about 65lbs.  Any suggestions as to what I should do to cover my A** ?  Hope you are feeling better!

I had my complications start 6 weeks after surgery which is really late I think.  At first when the vomiting started, I really thought that I had the flu or at the very worst a stricture.  I did pay the complication fund and based on others that were there when I was, it was the right thing to do.  It seems they come up with all kinds of extras to charge you for right down to extra staples that can end up costing more than the $500.00  I did do the pre-op diet and Dr. Joya didn't say anything about the size of my liver so I assumed it was fine.  I followed everything exactly as they said and still had a complication so I am thinking that I would have had a complication regardless of where I had the surgery.  My BMI was on the low side like yours,with no co-morbidities such as high blood pressure or diabetes and I was only 45 and very healthy.  Those being the reasons that I really didn't worry about complications. 

I would suggest that you get some protein bullets to bring with you.  The Drs recommended them but GNC in Mexico was no longer carrying them and the other protein alternatives there were very expensive.  Good luck.
Jennifer

Hi There Angel,
How are you feeling now?  Hope you are better?
I asked Gerald about the stitches and he told me they were dissolvable, but I heard someone else say she had BLACK STITCHES, whatever that means and had to get them removed once back to the States.  What kind did you have?
I'm assuming the PROTEIN BULLETS are something you mix into water or juice.
Hope you are doing better, THANKS again for the insight.
God Bless!

Joya charges extra for more staples?  Are you serious?  Any other extra charges you weren't aware of ahead of time?

yIKES!
Can you share what insurance company you were with? I hope it is not mine! Am hoping to have VSG some time in the next 3-6 months. Of course my insurance will not cover it so I am researching surgeons in Mexico.
70K is a scary number!