Self-pay advice?

on 12/1/17 11:47 am

My bypass is scheduled for Dec 20 and I'm self-pay. I obviously understand that means I'm paying for the surgery and follow-up but what I'm wondering is: what if something goes wrong? If I have to have my gall bladder taken out in six months, is that self-pay too? I'd love to hear if any self-payers have run into this situation.

on 12/1/17 2:34 pm

I think that depends on your insurance. Bypass is more of an 'elective surgery'. Having to get your gallbladder out is something you might NEED.

Referral: June '17 -- Nutrition Class: Aug & Sept '17 -- Dietitian: Aug, Sept, & Oct '17 -- Sleep Study: Oct '17 -- Meet Surgeon: Dec '17 -- Surgery: January 8th 2018!!!

BMI Clinic in Ottawa / Weight: 285lbs Height: 5'2 / Age: 25 / Nursing Student

White Dove
on 12/1/17 5:35 pm

You can purchase insurance to cover the cost of complications that might arise from the weight loss surgery. Ask your surgeon.

Real life begins where your comfort zone ends

Gwen M.
on 12/2/17 7:50 am
VSG on 03/13/14

I think it depends on your insurance and the problem and how it's coded. Ask your surgeon about what follow-up care they'll offer.

For example, this is something that's an issue for me with reconstructive plastic surgery. I had some wound openings that fall into the category of "minor" complications. If I go back to my surgeon, he'll deal with them for free. Worst case, I might need a prescription for an antibiotic if there's infection, but that would be covered by insurance. Since infection is.. infection. Insurance doesn't really "know" it's infection from a non-covered procedure.

HOWEVER, if I went to the ER to deal with the wound separation, then I'd have to pay for everything out of pocket. Because wound separation from non-insured procedure is clearly out of the realm of insurance.

(If you're curious, I saw my surgeon on Thursday and he dealt with things. Plus I've avoided infection so I didn't need an antibiotic.)

My recommendations to you?

Follow your plan TO THE LETTER. Err on the side of caution when advancing diet stages. Be super careful about keeping your wounds clean and avoiding infection.

Ask your surgeon about immediate complications and what they'll cover as part of the cost of self-pay. (Are you doing this surgery locally? I hope so? If you're doing it out of state/country, this is going to be much worse if you have a complication. In my case, my surgeon is a 45-90 minute drive depending on traffic. If my surgeon was in Mexico, I'd be ******)

Someone above mentioned special insurance - when I was looking into this for reconstructive surgeries I learned that it was something that had to be offered by the surgeon, so it might not be an option for you. Definitely ask.

I feel, in my gut (lol!), that something like gall bladder removal would be covered by insurance if medically necessary because there is no definitive causal relationship between RNY and gall bladder malfunction. Sure, there's correlation, and sure there's definitely a link between massive weight loss and gall bladder issues, but there's no definitive link between RNY and gall bladder issues. So I wouldn't consider that to be a DIRECT complication of surgery. And if insurance tried to claim that it was, I'd fight it tooth and nail with the aid of a lawyer.

So.. yeah. Complications are complicated. It's good that you're doing your homework in advance.

VSG with Dr. Salameh - 3/13/2014
Diagnosed with Binge Eating Disorder and started Vyvanse - 7/22/2016
Reconstructive Plastics with Dr. Michaels - 6/5/2017 (LBL&brachioplasty), 8/14/2017 (UBL&mastopexy), 11/6/2017 (medial leg lift)

Age 40 Height 5'4" HW 319 (1/3/2014) SW 293 (3/13/2014) CW 149 (7/16/2017)
Next Goal 145 - normal BMI | Total Weight Lost 170

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Gwen M.
on 12/2/17 7:58 am
VSG on 03/13/14

Specifically regarding gall bladders, this blog post links to actual research showing that fat keeps our gall bladders happy.

I read it when it was first published in April 2014 and remember thinking, "Huh. I wonder if the real reason people have gall bladder issues post-op is from going super low fat."

Oh - and ask your doc for a 6 month prescription of ursodiol (trade names: Actigall, Biliver, Coric, Deursil, Egyurso, Udcasid, Udiliv, Udoxyl, Urso, Urso Forte, Ursocol, Ursoliv, Ursofalk, Ursosan, Ursoserinox, Udimarin, Ursonova, and Stenerh). It's supposed to support gall bladder function and is often prescribed post-WLS for a few months as a prophylactic measure.

VSG with Dr. Salameh - 3/13/2014
Diagnosed with Binge Eating Disorder and started Vyvanse - 7/22/2016
Reconstructive Plastics with Dr. Michaels - 6/5/2017 (LBL&brachioplasty), 8/14/2017 (UBL&mastopexy), 11/6/2017 (medial leg lift)

Age 40 Height 5'4" HW 319 (1/3/2014) SW 293 (3/13/2014) CW 149 (7/16/2017)
Next Goal 145 - normal BMI | Total Weight Lost 170

Check out my TrendWeight

on 12/2/17 11:18 am

Gwen- thank you SO much for your advice. It gives me a lot of areas to research and figure out. I'm in the US and my bariatric surgeon is nearby so that's good.

When I went to my general practitioner for the pre-op clearance we were talking about complications and he said "Gall bladders are tricky. In the early days of bypass they would remove the gall bladder every time and I don't know why they stopped". It got me thinking about who pays if the gall bladder has to come out later (and honestly wonder if I should have mine removed with the surgery!)

Congratulations on your success! I'm sure it was a hard journey but good for you!

on 12/4/17 11:36 am
RNY on 06/26/17

Another option would be to take Ursodiol to prevent gallbladder. At least that's what my surgeon prescribed for me. I was told I need to take this for one year after surgery to prevent gallbladder from forming due to rapid weight loss.

M1-25.6 M2-11.6 M3-13.2 M4-9.4 M5-7.6

Citizen (USA & Brit) Kim
on 12/2/17 12:53 pm - Castle Rock, CO

I had my RNY 13+ years ago and still have my gallbladder. I have NEVER followed a low fat diet. Losing your gallbladder is definitely not a foregone conclusion!

Proud Feminist, Atheist, LGBT friend, and Democratic Socialist

H.A.L.A B.
on 12/3/17 7:13 am
RNY on 05/14/08 with

It may depend on the doc - the way he would code any issues after you had surgery. I am self paid. I had hernia repairs and GB removal. Since those 2 can happen with RNY or because of losing weight any other way ,- or just because ,- my doc never code the as "complications due to RNY". It was coded as independent issues. Same with my lab work.

Good luck to you.

FYI: since the WLS is medically necessary- make sure you keep copies of all medical bills - and see if they can be tax deductible. I had reconstructive surgeries (upper and lower body) medically justified- (rushes, yeast infection etc) so I was able to claim that on my taxes. My insurance did not cover any of that so I paid cash.

But - my face lift - I could not claim since I could not justify medical necessity.

Hala. RNY 5/14/2008; Happy At Goal =HAG

"I can eat or do anything I want to - as long as I am willing to deal with the consequences"

"Failure is not falling down, It is not getting up once you fell... So pick yourself up, dust yourself off, and start all over again...."

on 12/12/17 8:10 pm
I had an incisional hernia repaired a year or two after my RNY (self-paid) and insurance covered it with no problem.

Lap RNY February 15, 2012
Starting weight 195 (ht. 4'10)
Surgery weight 178.5
Current weight 113