Self pay - insurance problems down the road?

Pensgal
on 4/25/11 4:53 am
So I've made this life changing decision.  Done the work, got the money, lost some weight, lived through the pre-op fasting and am ready for Thursdays surgery when the pessimist in me started screaming.  Which led me to ask all of you - later in life, if I need an EGD or some such procedure, will my insurance company deny me because I've paid out of pocket to have this procedure.  Couldn't they claim that any future problem is related to this surgery and therefore a pre-existing condition or some such nonsense?

Just when I think I've gotten over the hurdles - I find another one.  I can manage paying for the surgery- but THAT'S IT!!!  Pray there are no complications!
Pensgal    
MrsHelm1012
on 4/25/11 5:02 am, edited 4/25/11 5:03 am - Washingtonville, PA
Hmm.. I am not sure about that one. I guess it would depend on your insurance. My insurance doesnt have a pre existing condition clause... But then again, I have Geisinger Health Plan, which is owned by the hospital my Husband and I work for, Geisinger Medical Center... So I am sure that has something to do with not having that clause...
    
jbskaggs
on 4/25/11 5:04 am - holt, MO
 Call them up and ask them.  Another option is to buy a medical plan that covers any complications from surgey.

JB
      
 
cannonkb
on 4/25/11 5:10 am - SC
You would need to check with your insurance because some insurance companies that do not cover WLS do also have exclusion policies for any complications if you choose to self-pay.  I know mine did.  The only reason my insurance paid for my surgery was because it was a pilot program mandated by a govt. priviso for 100 state employees because they were trying to see the cost effectiveness of the surgery vs. the comorbidities. I luckily was one of the blessed 100 chosen otherwise I wouldn't have been able to have the surgery.
        
Puppylovemommy
on 4/25/11 5:36 am - LA
I'm a cash patient and I'm just going to have to deal with it when it comes up later on in life!  If I don't do this, I might not have a later on to think about!!!
jbskaggs
on 4/25/11 6:10 am - holt, MO
 Amen!

I have no insurance and paid cash.  If though I did not lose the weight I am sure I would be dead in a decade or less.

Since I started the process in Jan and surgery in Mar my blood pressure has dropped, I sleep better, breathe easier, have a healthier appetite in the bedroom, can tie my shoes again, can workout without feeling like Im having a heart attack, no longer borderline diabetic, skin complexion has improved.   And so forth.

The thing about co-morbities is that any comorbity can kill you.  A medical bill is not as deadly.

JB
      
 
Puppylovemommy
on 4/25/11 6:27 am, edited 4/25/11 6:27 am - LA
On April 25, 2011 at 1:10 PM Pacific Time, jbskaggs wrote:  Amen!

I have no insurance and paid cash.  If though I did not lose the weight I am sure I would be dead in a decade or less.

Since I started the process in Jan and surgery in Mar my blood pressure has dropped, I sleep better, breathe easier, have a healthier appetite in the bedroom, can tie my shoes again, can workout without feeling like Im having a heart attack, no longer borderline diabetic, skin complexion has improved.   And so forth.

The thing about co-morbities is that any comorbity can kill you.  A medical bill is not as deadly.

JB
  I notice you had your surgery with Dr. Mario Alberto Almanza-Reyes'. Can you give details of your experience.  He is soooooooooooooooo much cheaper than where I'm having mine done... 
            
jbskaggs
on 4/25/11 8:28 am, edited 4/25/11 8:28 am - holt, MO
 A lot of people have used him.   First of all the experience is much more laid back and personal there.   I spent an hour talking to him and another talking with the director and another hour with the intake guy  the morning of my surgery.  Also I under went blood work, and an ekg and blood pressure by a cardiologist.  They were very friendly, clean, and answered all my questions.  All the furnishings were for BIG people- big robes, big chairs, etc so that you were not uncomfortable.

Financially: I sent a $500 down payment via paypal and I brought a cashier's check for $4000.  There was no hidden charges from the clinic. They sent me home with my needed aftercare medicines and letters for the airport so I could carry them on.  So I spent $200 on pasports, $750 airfare, and $4500 for surgery.

Safety issues:  the clinic picks you up from the airport and provides safe transportation to and from the clinic and all needed travel.  If you feel up to it they will even take you shopping or to San Diego zoo etc.  I never felt unsafe.  I wish I could have spent more time exploring San Diego though.  Because I really researched his clinic and watched all the videos about hi on youtube I knew what to expect.  Some people in my group were putoff that his clinic is in a strip mall.  That didn't bother me as it was clean, up to date, and efficient.

The surgery took 45 minutes.  I woke up mostly pain free- the gas was my only real issue.  I was walking within hour of surgery.  I had asked to see my removed stomach and they showed it to me.  It was pretty big.  I have five incisions about 1/2 inch long.  The doc did really well on the wounds cleanliness and healing.  But I tore one trying to get my kid into a chair and she kicked me. Not the doc's fault.

My follow up is with my home doctor- but the Jerusalem clinic emails me weekly and I talk to them about my progress and they happily answer my questions.

The Dr. is pretty thorough  in his assessment of your ability to undergo the surgery.  I have talked to several people who he made them postpone their surgeries until they got their pre complications under control.  One lady while I was there was postponed for three days until it was safe for her to have the surgery.

My only complaint honestly was cultural.  I did not speak spanish and the smells of spanish food was very overwhelming in the recovery house.  Yet every body there was very friendly and helpful.

I would recommend bringing someone with you while your there- it helps the time pass easier when you are with someone you know.

I have lost 26 lbs since then, my wounds are healed over now, and I eat most anything (except raw veggies)- though most people don't eat the way I do and have very restricted diets.  My home doctor put me on a different diet than the one Dr. Almanza had me on.  Almanza's diet is pretty much like most people's here: fluids first week, then soft and creamed foods 2nd week, mushies third week, progressive solids after four weeks. Oh and he requires a liquid only diet prior to surgery based on your BMI.  For me it was fourteen days.  Some people may have to have a thirty day liquid diet. others a three day liquid diet.

My coordinator was Louise Johnson.  I hope that helps you.
      
 
Puppylovemommy
on 4/25/11 9:45 am - LA
On April 25, 2011 at 3:28 PM Pacific Time, jbskaggs wrote:
 A lot of people have used him.   First of all the experience is much more laid back and personal there.   I spent an hour talking to him and another talking with the director and another hour with the intake guy  the morning of my surgery.  Also I under went blood work, and an ekg and blood pressure by a cardiologist.  They were very friendly, clean, and answered all my questions.  All the furnishings were for BIG people- big robes, big chairs, etc so that you were not uncomfortable.

Financially: I sent a $500 down payment via paypal and I brought a cashier's check for $4000.  There was no hidden charges from the clinic. They sent me home with my needed aftercare medicines and letters for the airport so I could carry them on.  So I spent $200 on pasports, $750 airfare, and $4500 for surgery.

Safety issues:  the clinic picks you up from the airport and provides safe transportation to and from the clinic and all needed travel.  If you feel up to it they will even take you shopping or to San Diego zoo etc.  I never felt unsafe.  I wish I could have spent more time exploring San Diego though.  Because I really researched his clinic and watched all the videos about hi on youtube I knew what to expect.  Some people in my group were putoff that his clinic is in a strip mall.  That didn't bother me as it was clean, up to date, and efficient.

The surgery took 45 minutes.  I woke up mostly pain free- the gas was my only real issue.  I was walking within hour of surgery.  I had asked to see my removed stomach and they showed it to me.  It was pretty big.  I have five incisions about 1/2 inch long.  The doc did really well on the wounds cleanliness and healing.  But I tore one trying to get my kid into a chair and she kicked me. Not the doc's fault.

My follow up is with my home doctor- but the Jerusalem clinic emails me weekly and I talk to them about my progress and they happily answer my questions.

The Dr. is pretty thorough  in his assessment of your ability to undergo the surgery.  I have talked to several people who he made them postpone their surgeries until they got their pre complications under control.  One lady while I was there was postponed for three days until it was safe for her to have the surgery.

My only complaint honestly was cultural.  I did not speak spanish and the smells of spanish food was very overwhelming in the recovery house.  Yet every body there was very friendly and helpful.

I would recommend bringing someone with you while your there- it helps the time pass easier when you are with someone you know.

I have lost 26 lbs since then, my wounds are healed over now, and I eat most anything (except raw veggies)- though most people don't eat the way I do and have very restricted diets.  My home doctor put me on a different diet than the one Dr. Almanza had me on.  Almanza's diet is pretty much like most people's here: fluids first week, then soft and creamed foods 2nd week, mushies third week, progressive solids after four weeks. Oh and he requires a liquid only diet prior to surgery based on your BMI.  For me it was fourteen days.  Some people may have to have a thirty day liquid diet. others a three day liquid diet.

My coordinator was Louise Johnson.  I hope that helps you.
Thanks so much for your input.  I feel better about considering going into Mexico to have this done.
            
Pensgal
on 4/25/11 11:44 am
well that is perspective for me! Thanks JB - much appreciated!
Pensgal    
Most Active
Recent Topics
×