If you were self pay but had insurance...

I'm asking to help my friend out.  She really wants to go to my surgeon for her surgery.  He's at NYU which is a great hospital and he is an awesome surgeon all around.  Her company recently changed insurance providers and my surgeon no longer accepts her insurance.  I recommended other surgeons that take her insurance but we just found out that her supervised visitation/diet is A YEAR.  She's really not sure what to do because she really likes my surgeon and doesn't want to wait a whole year (6 months is one thing, but A YEAR?).

Here's my question, if you were self pay for surgery but still had insurance - did your insurance cover other parts of surgery like anesthesia, hospital stay, testing done in the hospital?  My thinking is even though my surgeon doesn't take her insurance, NYU might and that could cover the costs of all the other stuff that comes along with surgery. 

I was going to post this on the insurance board but there isn't too much activity over there...

 

This is just a personal choice so take it for what it is worth.  If it were me, I would never self-pay if I had insurance.  The year sucks, but just get started and go with it.  If she does her homework it is very likely she can find a good surgeon- there are many out there now that do a great job.  Don't get me wrong- if I did not have insurance I would for sure be a self-pay.... but I would go to Mexico where it is a boatload cheaper.  The prices here in the US are astronomical once you factor in the hospital costs and such.  My procedure was 28-30 grand.  Never could have done it without insurance. Mexico is running around 9 grand right now I think, but she would need to check that because I am guessing a bit. 

We both realize that it is illogical to pay for something when insurance will cover it but we're just exploring the options right now because she really felt comfortable with my surgeon.  It has taken a lot for her to warm up to the idea of surgery so that's why I'm just helping her out to figure out all the options and the best course.  Thanks for your input :)

I agree. I'd tell her to at least get going on that year right now, then she at least has that ball rolling, and if she really decides to go a different route then she can.

Edited to add:  I get it. A year would totally suck, but if you look at the whole picture one year is worth the lifetime of better health.

My insurance did not cover my surgery so I was a self pay.    As far as the all the pre-opp testing, my surgeon coded in such a way that the insurance company did not know the tests were for WLS.  Most of my tests and blood draws were covered by insurance minus the deductibles and such.  Anything related to the actual surgery was all on me to pay. :( 

From my personal experience and not speaking to the surgeon/insurance issue.  Now that I am post-op and with all I went through over 8 months of learning to eat for post surgery.  I'm glad it took so long to get my surgery.  I followed the post-surgery diet (which is required by my clinic) and learned so much about myself.  I had a lot of hiccups along the way and worked through them.  I feel much better prepared to live this life then I would have even at 6 months in.  My biggest aha! moment came about a month before surgery.  The wait was painful but really worth it for me.

*Just a little light at the end of that long tunnel if she chooses that route.

I was self pay because my insurance wouldn't cover it. My case was similar to Cheryls222. So the most of the tests were covered and the wls doc program included some tests in their price but if they have insurance and its covered its best to go thru it. It's very expensive and if u need plastic surgery after its just a lot of money that could've been prevented. It's no fun having to wait but time will go by quickly. Hope this helps and good luck to ur friend.

I'm assuming the one year requirement is from her insurance company?  If so, then insurance won't cover anything related to the surgery because she hasn't met the criteria, no matter which surgeon she goes to.

you make a good point!  Thanks.

I would call NYU  or the insurance person at your surgeon's office. But I don't think her insurance would cover associated costs because they would be coded to WLS and she hasn't met the year requirement.  It was my insurance, not the surgeon, that required the six month diet for me.

Good Luck to her.

Elisa