Question:
What would you do? Self Pay March 2005 Vs TRC Pay January 2006
I currently have no health insurance but I am desperately seem the RNY surgery as I am six foot tall and weight 415 pounds. After being evaluated off and on for the past 6 months by the TRC they have said, unofficially, they would pay for my surgery after my completion of a one year medically supervised weight loss program if I still want and need it. I have also been pursuing self pay options and found having the surgery done in Ensanada Mexico to be the most affordable option with the total cost with expenses being around $12,000 for the open RNY. So do I wait, and hope, for the TRC to approve my RNY Lap surgery in 2006 or do I take out a $7,000 loan plus $5,000 I already have and fly to Mexico to spend $12,000 for the OPEN RNY in March 2005? — DJHenryD (posted on January 4, 2005)
January 4, 2005
My concern would be complications. I ended up back in the hospital for a
second surgery about 2 months later, and had several emergency room visits
as well. Would your insurance cover that? Not to mention the many surgeon
follow-ups you have initially. It may be wiser to wait.
— mom2jtx3
January 4, 2005
I do not know what TRC is, so I'm stabbing the dark here, but I am thinking
it's some sort of rehab program. One thought is if you can officially
apply now and get a written denial and why you are being denied and maybe
they would indicate their criteria in that letter. Many denials will say
that you do not meet the required doctor supervised diet etc. If there is
any way to get them to put in writing why they are denying you now, then
once you meet that criteria you would hopefully have a better chance of
getting the approval. It is a crap shoot to a point, but the potential
risks of post op problems and ending up with many many thousands of
hospital bills is there. I saw my surgeon about every 5-10 days for the
first 3 months because I had wound healing problems. After my first PS I
saw that surgeon almost as often for 2 months. Usually any post op
problems will not be covered by any future insurance when you are self pay.
Versus if you have it done under this other program you would likely have
any PO problems covered while you were still under that program. Once you
have health insurance again there is a good chance nothing related to WLS
will be covered. Some things can be hid by your PCP but obvious things
will flag the insurance company and they will investigate. All I can say
is if you go for self-pay now, you need to have additional money available
to you should you need it. Good Luck! It certainly isn't an easy
decision.
— zoedogcbr
January 4, 2005
I would get financing and have the surgery at a hospital in the US. The
thought of going to Mexico for something so important scares me, and your
life is to important to cut corners on. I also wouldn't pin a year of my
life on my insurance company.
Who is to say that in a year they might stop covering WLS alltogether.
— theresa R.
January 4, 2005
I have a friend that went to Mexico last Feb and is doing great. There is a
South of the Border forum if you want specific answers from the people that
have actually taken this route. Click on the "Communities" link
up at the top of the page and the link will be on one of the drop down
menus, Other Forums. It will be the 3rd on the list.
— Ali M
January 4, 2005
There are several posters here who have had their WLS and plastic surgery
successfully done in Mexico. As another poster said, i would be concerned
with the after care from your surgeon not being readily available. If
there are no complications, your good to go, however, I, too, required a
2nd surgery 5 days after the lap RNY due to a twisted bowel. It was very
comforting to have my WLS surgeon there to operate on me for the 2nd time.
If you can wait a year, you may want to do so in the hopes that TRC will
pay, since they seemed to indicate that they would. A year can go by very
fast and in the meantime, you can try their one year medically supervised
weight loss program which should be somewhat successful and lead to a
healthier weight when you do have the WLS. If TLC turns you down at that
point, then look into self pay.
— Cindy R.
January 4, 2005
I would wait it out. I would not trust going to Mexico for the surgery. I
understand what you are going through but trust me one year will whiz by
fast. Besides how do we know if the hospitals in Mexico can meet the same
standards as our hospitals here in the states. US hospitals have to
maintain certain standards and are reviewed by different organizations and
recieve "grades". It's so easy to catch a hospital born
bacteria. All it takes is for someone not to sanitize something properly
or not wash their hands in between patients. I would feel more comfortable
in a US hospital.
— Kara J.
January 4, 2005
If you are able to safely wait for the surgery (healthwise), I'd do it and
save the self pay for future PS. I know that many have done well in Mexico,
but I'd feel more comfortable having it locally where there is a back up
system for complications. My wls surgeon is still only a call and a 30
minute car ride away, and even at almost 2 years out, I find that very
comforting.
— Fixnmyself
January 4, 2005
My suggestion is wait I know it is a long time but what if you get an
infection who would take care of you? My sister in law had an OPEN and has
had major problems and not in MEXICO I had a LAP by a Dr here in Texas
that has a great cash package less than $ 20,000 if your interested e-mail
me and I will send you his name and number I did great and have not had a
problem and they don't have a really long wait either. Good Luck....Nancy
— nefish
January 6, 2005
I understand how you feel about not wanting to wait. But I agree with some
of the other posts about secondary complications. If you are going to be
staying in Mexico (or close to it) then I don't see a problem with having
the surgery in Mexico because standards in their hospitals have greatly
improved and especially the ones that specialize in surgeries such as this
one - and I have to disagree with what a prior posting just mentioned -
because they DO have guidelines and standards that they must meet before
admitting patients. They also are a cash-based system, which means no cash,
no services - so depending on where you are going in Mexico you may even
like it better than here AND the more cash you got the better care you will
get. But if you have no plans on staying near the surgeon that performs
the surgery, I would recommend waiting for your insurance to pay - that way
IF there is any secondary complications and ESPECIALLY for the follow-up
visits, you are covered. GOOD LUCK! Kelly
— Kelly MzKelz Valdez
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