BLIS - Worth it, or just a gimmick?

[Sunshine Too]

NOTE: I'm still working through insurance issues, but for purposes of this post assume I will be self pay. I have serious concerns about possible complications following self pay DS surgery. While relatively rare, these can add up to hundreds of thousands of dollars in extreme cases. I'm still researching my normal health insurance, but knowing insurance companies, I fully expect I would have to fight to get them to cover complications resulting from a surgery that was self pay.

So I've seen this BLIS complications insurance. I contacted them and they currently offer coverage for only 3 surgeons who perform DS:
Daniel Cottam (Salt Lake City, UT)
Stephen Boyce (Knoxville, TN)
Michael Blaney (Augusta, GA)

Of these I know Boyce is vetted. I am not personally familiar with the other two. Boyce has good self pay program $25,750 which includes some coverage level with BLIS. My understanding is that there may be additional levels of coverage that you could pay extra for if I wanted.

Does anyone have any experience with BLIS insurance? Do they actually pay, or is it so filled with exclusions that it really isn't worth the paper its written on? And does it really cover the actual possible complications that are most likely to occur?

Right now my first choice surgeon is Ayoola in Texas. I'm comfortable with him, the lengths he would do on CC/alimentary, and he's convenient for me to get to geographically. His self pay is also about $25k, but it does not include BLIS. So I am considering looking at Boyce for the sole reason that he offers BLIS.

 

[Larra]

Dr. Cottam only does the loop DS (he calls it SIPS) these days, not the real, 2 anastomosis DS. I've never even heard of Dr. Blaney.

I know nothing about BLIS.

 

[Clematis]

The last time I checked, BLIS didn't cover DS at all so I guess it is good news that there are 3 (or, well, ONE if you remove Cottam and Blaney). Since they didn't cover DS, I didn't examine the policy. I did read the fine print on the policies for international insurance and if it is anything like that, you have a reason to be wary. One was $75,000 of coverage for $2,500 premium. But "up to" $70,000 of that was for transportation for you and a family member leaving only $5,000 of actual medical coverage. Really stupid.

BLIS was offered "free" for 30 days post-op by a high priced surgeon at The Cleveland Clinic -- since they do few DS procedures, I don;t think they even realized that BLIS would not have covered the DS. But then one reads of dsriggs having (what was it, scott?) $75,000 of revision surgery far beyond the 30 day cutoff.

I think the key is to choose the BEST surgeon and then the risk of complications is greatly reduced. Start making a list of the people who have to have emergency surgery because of complications, note their doctors... and then don't go to them!

I went to Esquerra in Mexicali. $11,000. If I had had a complication and could not get back to MX, I would still have had money left in the surgery kitty to cover US care.

 

[Spiky Bugger]

In-house cynic here...looks to me like doctors sell "protection" to patients. I wonder if the patient has to go back to the surgeon, who (may have) screwed things up in the first place, to get him/her to "correct" things. ???

Have you considered Mexico and pocketing the difference to use in case of complications? Or have a new wardrobe if no complications?

 

[Sunshine Too]

Wise posters indeed! BLIS does an underwriting on the surgeon, examining how many procedures they have done, complication rates, mortality rates, etc. If there are complications, BLIS requires you to go back to the same surgeon. I don't think this is a way of the surgeon steering future business back to himself. Rather, its BLIS making the surgeon deal with whatever problem he may have created in order to keep himself in good standing with BLIS. This could be a problematic exclusion, however. What if you're far away from your surgeon and you suddenly have bleeding or obstruction that needs immediate surgery. Would this be a basis for BLIS to deny coverage. I will continue to try to find out further details and report back. I think complication insurance is a very good idea for self pay patients. But its got to "have teeth" and really pay in order to be effective. i.e. Square Trade for bariatric surgery.

 

[southernlady]

Well, Boyce's office has offered this option for well over 5 years now (I saw it back when I was pre-op) and his complication rate is available if you ask. I did at one point but the data I gathered is going on 3 years old now so it's not relevant any longer.

Okay, I am gonna mention Dr. Boyce as a RNY to DS revision surgeon. When I asked back last July (2013) for his information so I could pass it along, this was what I got back, My question in black. Her answer in Red.
Got this from his Office Manager, Robin is his nurse:

There is a list of Duodenal Switch patients from ALL over the country who help others learn about this particular surgery and which surgeons do the procedure.

I want to add Dr. Boyce to that list but we need a few details if you don't mind answering.

1) About how many DS surgeries has he done (not the practice but him) just over 500.

2) Complication rate? 10%

3) Where did he learn the skill to do a DS? Who was his mentor? Dr. Smith in Atlanta and thru 24 years of experience with Weight Loss surgery.

Robin said he has done revisions (lap band to DS or RNY to DS.), yes both

4) About how many revisions to a DS has he done. 155

The 10% was back in June/July 2013...
Whether it helps in your decision, I don't know. I do know of someone pretty local who is an Ungson DS'er and no one in this area will touch her for more than basic PCP care since she had surgery out of country.

 

[Clematis]

no one in this area will touch her for more than basic PCP care since she had surgery out of country.

Nor do they want to take on any other surgeon's patient even across the country. What I was told is that a surgeon doesn't want someone getting surgery elsewhere and then showing up wanting routine follow-up care -- that boring stuff that they really don't want to do even for their own patients. If you show up in the ER and they get to cut you open, hey, they like that. (Unlike surgeons here, Mexicali makes a video of one's complete surgery. No surgeon can ever say to me "I don't know what they did.")

 

[southernlady]

Nor do they want to take on any other surgeon's patient even across the country. What I was told is that a surgeon doesn't want someone getting surgery elsewhere and then showing up wanting routine follow-up care -- that boring stuff that they really don't want to do even for their own patients.

True, which makes it hard if you move or if your surgeon dies or retires, etc.

 

[DianaCox]

You also need to look at your OWN insurance contract (the full Evidence of Coverage, about 100 pages, not the Summary of Benefits). When I had my one and only plastic surgery self-pay, I had been denied for coverage; however, my insurance coverage included complications for procedures which were NOT covered. You have to look for this yourself. Don't pay for something you don't need.

 

[duh_Mom]

@Sunshine Too - I am a Boyce patient that was partial self pay 8 months ago. BCBS IL paid to have my lapband removed I paid the rest of it. Yes BLIS is included for DS complications. The office offers you "other" coverage for Stricture - that is good if I remember correctly - for 2½ years. They also offer a second policy for complications of PE. - I can't remember how long it was good for but seems like a year or more.

I did opt to get the coverage for stricture but not for PE. It was like 400 dollars.

So, I did have some pretty severe complications early on - surgical - which would have been covered by the Boyce provided BLIS - I required a second surgery - and a longer stay in the hospital. I came home then bounced back after 2 days and was a 23 hour admit with a thorocentsis (fluid on lung.) When I presented to the ER they thought I had a PE with my symptoms - had CT scan, ER visit, DRs to read all those tests etc. I also had additional outpatient tests - abdominal CT and unplanned labs.

I list all this out because I never received a bill for any of it from the hospital. I know my insurance did not pay it because they did not have that information. The bill I received from Dr. Boyce's office was taken care of by either them or BLIS - not sure which. I did not pay Boyce anymore money - even the co-pay amount for the bad removal.

So, did BLIS pay it - unknown to me. However, I felt/feel better having the stricture coverage. Honestly did not choose Boyce because of the BLIS - chose him because of his reputation.

Good luck with your decision!

 

[Sunshine Too]

You also need to look at your OWN insurance contract (the full Evidence of Coverage, about 100 pages, not the Summary of Benefits). When I had my one and only plastic surgery self-pay, I had been denied for coverage; however, my insurance coverage included complications for procedures which were NOT covered. You have to look for this yourself. Don't pay for something you don't need.

Diana, I hear you and I'm trying to determine what coverage I have. I've been trying since December 18th to get a copy of my contract. Still no luck but I keep trying. My plan is employer funded by my wife's employer, which is a Fortune 500 company. There are two people at headquarters HR who deal with benefits and insurance. We call them about every 2-3 days to ask for an update and so far nothing. I even had my wife send the following:

Please provide a written or electronic copy of the current versions of: (29 CFR 2520.104b-1(b))
· Summary Plan Description (SPD)
· Form 5500
· Any plan documents which govern availability of benefits (i.e. Evidence of Coverage, Benefits Manual, or other policy documents with United Healthcare)
· Any plan documents which provide specifically for benefits related to bariatric surgery

Please provide a written or electronic copy of the current version of:
· Summary of Benefits and Coverage (SBC) and Uniform Glossary (29 CFR 2590.715-2715)

Please confirm in writing if the plan is a grandfathered plan. (29 CFR 2590.715-1251)

So far the only response I have received is that we are not a grandfathered plan and that the SPD is in the process of being updated and is unavailable. They can't/wont even tell me who the official Plan Administrator is. As I'm sure you know, most of the above requests have federally imposed deadlines of so many calendar days for them to provide. We have also been through several departments at United and they are worthless as well and haven't provided any of the above. I continue to press for the insurance docs, but I'm also running parallel track on due dilligence on self pay.

 

[Sunshine Too]

@duh_Mom Thanks so much for the info. It sounds like you were covered under the basic BLIS plan that is included in his self pay. I think that covers all complications for something like 60-90 days. Did you see Boyce at his hospital for the complications, or was another hospital/ER involved? From what I'm readying, it sounds like you have to have the complications dealt with by Boyce at his facility. I'm in New Orleans and he's many hours away in Knoxville. So if I had a PE or something emergency, I would have to be seen (at least initially) at a local hospital. Not sure if BLIS would cover that. The extra coverage does sound affordable, and for a lengthy time period. Glad to know at least someone has some experience with BLIS paying.

 

[Sunshine Too]

I contacted BLIS and asked for a copy of the actual insurance policy. Their response is below. Sounds like the cover a lot with $50k cap. They also sent me the pricing list with the specific coverages for Dr. Boyce. Its listed as "property of BLIS" so I won't post publicly here, but if anyone wants a copy PM me and I will send it to you.

BLIS response:

Thanks for your response and questions about the program. As you have probably learned, BLIS insures surgeons and then patient's are listed under their surgeons roster of protection. The actual policy is in Dr. Boyce's name so I can't send you a copy of the actual policy. Attached is a breakdown of the protection package options that Dr. Boyce has in place for his DS patients. This document will provide you with a breakdown of the protection timeframes, included complications and applicable pricing. Regarding what would be included, any bills related to one of the selected complication headings would be included under the BLIS Program including facility fees, anesthesia fees, physician fees, home health, medication, etc. as long as Dr. Boyce diagnoses and authorizes your care. There is a benefit limit of $50,000 on the program, but BLIS does have behind
the scenes agreements with facilities regarding how we pay on behalf of our BLIS Surgeon for complication related care so that $50,000 typically will go further.

 

[duh_Mom]

@Sunshine Too - yes the return to surgery for strangulated bowel and resultant shock happened before I left the hospital. The additional tests and ER visits were all done at Tennova which is where Dr. Boyce practices. He has his own little kingdom there really. Boyce did the second surgery and the radiologist did the thorocentesis.

 

[DianaCox]

One day in surgery and ICU would be more than $50K without concessions.

It is not promising that your plan is employer funded (i.e., self-funded). That means they can provide less coverage - the minimal ERISA coverage - than your state would require from fully funded plans.

You want the Evidence of Coverage, not the summary of benefits. And you want their bariatric policy document.