Question:
Not really a question, more of a request for information.

Kind of a long story so I apologize in advance. My local doctor thinks that I am a good candidate for surgery. He sent me to see a surgeon out of state and out of my insurance network. He also says I am a good candidate. But my insurance company wants me to go see a doctor in-network not to get a second opinion but because they say they want me to see the difference in cost between in and out of network. The in network provider is the Mayo Clinic in Rochester Minnesota, my insurance company is MMSI. Has anyone else ever had this happen to them? I really do not mind paying the out of network costs because I am not really a fan of the Mayo clinic because of a previous medical problem that they refused to treat. Could anyone that has had a laproscopic gastric bypass, or a lap-band placed please tell me what the costs were to you, and whether you were in network or out. I am also looking for information on the Mayo Clinic and your experiences with them regarding this surgery, and any info on MMSI. You could also email me at [email protected] if you do not want to post a reply. Thanks for any help that you can give me.    — Mini Gadget (posted on September 6, 2003)

September 6, 2003
My reply will probably get long. Even though I live in the Rochester area and work in Rochester, up until now I was not what you would call a great fan except in cases of severe trauma and transplants, etc. I was referred to Mayo for my RNY and so farI have been very pleased with the process and the people that I've seen. Their whole process is geared toward making you aware of what surgery is and will or will not do for you. My first appointment was with endocrinology where we went over my medical & weight loss history and my family's medical history. Since I was a good candidate for surgery, he went into detail about which surgery he recommended, how it was done, possible complications, and what to expect post-op. He talked about lifestyle changes I needed to make and changes that would be forced on me by surgery. He also stressed that if you did not make lifestyle changes, you could gain all of your weight back (he has a patient who kept it off for 8 years and gained it back). Then he asked if I still wanted surgery. Duh!! He scheduled appointments will pulmonary functions, psych, and dietician. Pulmonary did a resting metabolism study (I'm 10% below normal and need to increase exercise before surgery) and sent me home wich a device that recorded by sleep oxygen levels and pulse. In psych, I filled out a 90 question questionaire. We then talked about my weight loss (gain) efforts, any bouts with depression, any binging or purging, any suicidal (homocidal) attempts, and your personal body image. I was then scheduled for the 16 week LEARN program (a must before they'll do surgery). LEARN is an educational tool for changing your lifestyle habits that got us where we are before surgery so that hopefully we will not return there. I've gone to one session so far and at least my group also plays the role of a support group. You can say as little or as much as you want. The dietician gave me material about losing weight before surgery and also (once she realized I had decided on surgery) materials about post-op eating. I'll see her once a month until surgery and I'm not sure how often after surgery. I've had a followup visit with endocrinology and discussed my other visits and the results of the sleep study and the resting metabolism. It looks like I have sleep apnea so I get to spend a night at Mayo in October doing the sleep study. He also scheduled the surgeon consult which is Dec. 3. The next time I meet with endo will also be that day. This is where I am now. I don't know how often you meet with the surgeon before surgery (at least twice and this may very with who you get). There will be 4 surgeons doing WLS at Mayo by Dec. From what I heard, they are all very good with post-surgery care. Good luck with your journey.
   — ssundlee

September 6, 2003
My suggestion is to go see the surgeon at Mayo. Just because you had a bad experience with one group of doctors there are many hundreds of doctors at Mayo and they are not all the same. Make your decision based on who you are most comfortable with, not the cost if you are comfortable with covering the additional costs. Check them both out and then decide. I chose my surgeon totally on reputation and y comfort level with him. I did some initial checking out of what things would be covered and how much but that's it. I wanted this person and I was prepared to deal with what wasn't covered.
   — zoedogcbr

September 6, 2003
There's a third surgery you may not have heard of, the DS. I hope you'll research it at duodenalswitch.com before deciding. Post op eating is easier, there are fewer complications, and the rate of regain is very low. Dr Buchwald at UMN is an excellent DS surgeon.
   — Chris T.

September 6, 2003
I had RNY with Dr Raymond Drew of General and Vascular Surgeons at Abbott Northwesten Hosptil in Minneapolis. I don't know if they are in your network but he is definately worth checking out. He is a fantastic surgeon. I wound up having problems during my surgry as my tissues turned out to be very very poor. If it was not for his skill I would have died. It is very important to have great faith in your doctor and his/her program. It is also important that you keep in mind the financial impact of paying/owing such huge medical bills on your future. We are still paying on medical bills from a couple of years ago for another family member. It has really put a strain on the whole family and my marriage. Thankfully we only have another 6 months to go. It would take YEARS to pay off this sugery out of pocket.
   — Kathy J.

September 7, 2003
I went out of network for my RNY...the doctors in network were only doing open, and the one who was doing lap had only done 2 surgeries... so I was appoved by my insurance to go to an out of network doctor, and I did not have to pay a cent beyond normal co-pays. If you meet with the Mayo surgeons, and are not comfortable, have your primary doctor write up a request for out of network to the surgeon of your choice.. you will have to show good cause to go elsewhere, but if you push it, you've probably got a good chance of getting it. (at least that's the case with insurance companies in my area). Good luck.
   — Kelly B.

September 7, 2003
I had my lap RNY done in LaCrosse, WI at Gundersen Luthern Hospital. I had to pay out of pocket-my insurance stood by their exclusion policy- and the cost was $30,000. Since then, they have raised the price to $35,000.
   — kararuck