Expensive surgery, part deux
Most patients don't figure in the prospect -- or cost -- of going back under the knife after their initial surgery. But there are a few reasons you might end up in the OR again.
The first is unpredictable: You could be among the few who have complications from the initial surgery or need to have it redone. The ASMBS reports that you have a 4% chance of major complications with gastric bypass surgery, and 1% with Lap-Band. These include things like gallstones, scar tissue that can prevent food from passing into the small intestine, internal hernia, or a bleeding ulceration. The chances of needing a second surgery are 2% to 3% and 10% to 15%, respectively.
Fortunately, "if your insurance covers the initial surgery, it will cover the follow-up," says Ponce. But with a 20% coinsurance, you'd still likely be looking at a four-figure bill on a second hospitalization.
To hedge their financial risk, those going out of pocket for the initial surgery might ask to pay upfront for a package that includes the procedure, follow-ups for a year or two, and treatments for complications arising in that time, suggests Ponce. "We do believe that to plan for the surgery, you have to plan for follow-ups -- especially the critical first year -- and complications," he says. (Patients who get the Lap-Band typically require more follow-ups -- as often as every three to six months -- to check and adjust the tension in the band. That treatment is typically done in office and can cost about $300.) Some surgeons actually require uninsured patients to buy a policy through them to cover common complications.
The other reason you might need surgery is to remove the loose skin on your hips, arms, chest, legs, and abdomen after losing the weight -- an elective procedure that ranges in cost from $10,000 to $25,000, according to Joseph Nadglowski, president of the Obesity Action Coalition. (I didn't choose to have this done, in part because of the price, but also because I didn't find it necessary.)
Insurance coverage is possible only for loose-skin removal that's medically necessary -- and even then, getting approval can be tough. Retired New York City publicist Patt Levine had no problem getting her 2003 Lap-Band surgery covered. But when she asked her insurance to cover plastic surgery to get rid of the excess skin impeding her mobility after losing 100 pounds, she was denied. "They considered it cosmetic," says Levine, who is author of Eating Well After Weight Loss Surgery. Only after an intense campaign by her brother-in-law, an attorney, was she able to get reimbursement.
Doctors and patients point out that when it is covered, the surgery is not Beverly Hills-style body toning. The purpose is to alleviate a medical condition, not to make you look gorgeous. Mike Hajj, who was able to get coverage because of rashes caused by his loose skin, was cut from the breastbone to the groin, with 13 pounds of subcutaneous skin removed and 600 stitches required "to move the stomach muscles back where they should've been," he says.
A new (cheaper) lease on life
Some of the costs of the surgery, I'm told, will continue until the grave -- which is now hopefully further away. There are follow-up visits with Dr. Belsley, of course, just once yearly. My vitamins, minerals, and daily protein shake add up to $40 a month. Another $20 goes for smoked fish to keep my blood pressure from getting too low, ironically enough.
For some people, a big weight loss also means having to buy a new wardrobe -- or two or three, depending on how quickly you lose weight and how much you keep off. In my case, I had hung on to a lot of my older "thin" clothes in hopes that I'd one day fit into them again.
Doctors also encourage exercise to keep off the weight, which may add gym fees to your list of expenses. I'd already had a membership -- which I, of course, never used. I do now.
All the new expenses I'm incurring have been offset by savings in other line items. My eating habits, and subsequently food costs, are now totally different. I've gone from spending up to $1,000 a month on food to $300, netting $8,400 a year. My health savings are less easily quantifiable, though probably considerable. Not only have I said goodbye to high blood pressure, but my blood sugar levels are pristine, so the threat of diabetes is greatly reduced. Who knows what other health conditions -- and inevitable bills -- I'd be dealing with had my weight continued to rise?
For most obese people, surgery ultimately does pay off financially, experts say. "Depending on the medical problems you have, you can have a return on investment in two to four years [if you have insurance coverage]," he estimates. It could take longer for someone paying out of pocket. But, he says, "they will still get a lot of benefits over the long term."
Mind you, this is not a simple cost-benefits equation for most patients. "The quality of life improvement is dramatic," says Hajj, whose medical issues vanished weeks after the surgery.
There are also the psychological benefits. A year after the surgery, I went to a professional function and was greeted by blank stares from people who didn't recognize me anymore. I couldn't find a word in the dictionary to describe how that felt. The closest I could find was "priceless."
|Supplements||$40/month||Because surgery changed how my body absorbed nutrients.|
|Water bottles||$20/each||I must drink 80 ounces a day to fight dehydration.|
|Gym membership||$90/month||My doctor prescribed exercise. I took up jogging.|
|Smoked fish||$20/month||Keeps my blood pressure from going too low.|
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