First baby steps of my journey

[meganrae<3 14]

So I payed a visit to my PCP and discussed VSG, and he was all for the idea so I was jumping for joy. I THOUGHT that would be the hardest part of this process and I thought for sure that I had this surgery thing in the bag, good lord was I wrong. I have to admit that I'm super naive to how all this insurance stuff works, having the luxury of my mothers help my whole life. Well, after my PCP visit, I decide to "come out" to my mother (having not told anyone, because I feel it's humiliating ), explaining that I decided VSG was for me. Come to find out, our insurance doesn't cover WLS, under no circumstances, no matter what comorbidities you may have or what your bmi is. So now I've been cracked out, doing my research, looking for new insurance. I read stories about how people go from PCP to surgery in a month....how?! Everything i'm finding requires like 6 month medically monitored diets, and however many months of counselling...blah blah blah. Now that I see I have so many road blocks, I'm feeling a bit discouraged and defeated. How did everyone keep their sanity while doing all this nonsense? Or maybe any insurance suggestions? I just want to get the ball rolling already!

[Elode 8,093]

@@meganrae<3 It's usually quit the process, and Im sure For a whole heap of reasons but a big one is they want people to be prepared and understand what their getting themselves into. I'm not so sure a one month and done process Would be healthy or advisable for most. My requirements were shorter than some I only had to do a 3 month monthly checki-in. I didn't have any health issues but my BMI was right on 40 at the first weigh-in and with my insurance I qualified and was subsequently approved on the first attempt. As far as your insurance not approving wls that is going to give you a whole new set of issues with finding a insurance company that does approve it. I have BCBS FED So unless you are a federal employee or married to one ect...I don't think mine would be a possibility BUT do your research and find something. I have a feeling your in for quit the wait but if it's something you truly want you will wait it out and succeed in having it done. Another option is going to Mexico and paying cash. I can't speak on that because It wasn't the route I took but there are people on here that have and could help you out with that I'm sure. Good luck to you! Patience is a virtue !

[meganrae<3 14]

@@Elode I'm super stressed that even with good insurance, I may not qualify. I've had a BMI of over 40 since I was 19(I'm now 25), but 2 years ago I made an honest and hard attempt at losing the weight, I lost 91 lbs. I've now gained 50 back since then(UGH ), which has put me back over 40 BMI, and have had a few visits with my pcp throughout it all, so it's documented, and it wasn't his or a NUT's monitored plan. I'm worried that whatever insurance I have will see such a big fluctuation in my weight and consider me to be able to lose weight on my own. I've also definitely considered mexico but it's terrifying to think if I were to have a leak or form any sort of infection, I'd instantly be consumed by medical debt, being that I'm pretty sure any insurance wouldn't help with it. It's just so much that I don't even know where to start. I'm not even sure who I'd ask all my questions to. Do I ask my potential insurance? Is there things I shouldn't say to them? I feel weird asking them about their WLS coverage right off the bat, because then they'd know I plan on trying to get surgery on their dime. Thank god for this forum. I just feel like there's too much I don't know, and after hours and hours of research, I'm learning a ton, but it's not quite answering all my questions. ahhhh !

[BLERDgirl 6,417]

It's typically a 3 -6 mth process through insurance. The exceptions are typically when people have so many co-morbities that the surgeons help push things through. The other option is self pay and they go through because they are paying. You can still qualify without the BMI if you have other factors, but the first step is to find and attend an informational seminar in your area. If there isn't one then I would recommend contacting a few programs in your area and asking questions. When looking for insurances most have websites that lay out what their plans cover online. You can look them up for yourself.

[Elode 8,093]

@@meganrae<3 The one big fear I had during my process was the fact that The requirements said I had to have a BMI of 40 with proof for two years documented and I like your self lost a huge chunk Of weight just less than a year before (for my wedding) I was down to 197. Being 5'8 That put my BMI at 30 so no where near where it needed to be. I to this day have no clue how or why they approved me?! I did write it all down for them And on top of that I only have two documents I could give them for the two years because the clinic I was going to to do my travel nursing blood work, physical ect closed down and that's all I had. My other document had 220 as the weight which was only maybe a 34 BMI. But like I said at my first weigh in I was 256 so rt on the money. (I actually had to gain 6lbs) . My husband works for the federal government and he just added me to his insurance plan and within a week I was on the phone grilling them with the questions about how to get approved. I had the insurance maybe 3 months on the day of surgery. You will probably want to get approved for the insurance before you start Asking about the requirements...or not I don't think it really matters. If you find one and you know wls is in the plan then go for it! Mexico would be a little scary but that was my plan B. Truthfully I am lucky that I had a great surgeon and I'm thankful that my office visits are all paid for by insurance (along with my surgery) so my whole out of pocket was @500 for everything BUT If I couldn't go see him once every month and now every 3 I would be fine. All they do is weigh me and ask how I'm doing, give me a Vitamin b-12 shot and I'm out the door. I have been lucky not to have any complications though.

[della street 213]

My insurance (hubby's work policy) also explicitly EXCLUDED any form of weight loss surgery -- every year, for the past TEN years, I'd get my hopes up a bit during open enrollment time, only to have them dashed when the new policy came thru, which of course, once again, didn't cover it. So this year, I checked into a policy on the Affordable Care Act Marketplace ("Obamacare"). Lo and behold, I found a policy that covers the surgery!! What I found out is that in some states, weight loss surgery is REQUIRED to be a part of Obamacare policies. Of course, some will cover it anyway, but at least here in AZ, it's covered on those policies purchased thru the Healthcare Marketplace - of course, each policy has diff requirements, coverage parameters, types of surgery covered, etc -- and then there's the monthly premium for the insurance and the out of pocket max -- BUT -- in my case, at least, it is do-able. So I took the plunge and went off hubby's work-policy which no-way, no-how covers it (I was told "even in cases of imminent death" - UGH), to a policy that I pay for, but the premiums plus out of pocket w/still be WAY less than cost of surgery. So, something to look into...

[Kindle 8,667]

My insurance is like yours...no WLS no way no how. And the state I live in did not have any individual policies available from ANY company that covered WLS. (My state opted out of the Obamacare WLS requirement) So short of moving to another state or selling my business and getting a new job with a company who's insurance did cover WLS, I was on my own. So I turned to researching options in Mexico. I found a surgical team at an International Center of Excellence in Tijuana with more experience and better credentials than any of the bariatric surgeons within 200 miles of me. I used the money I was saving for a down payment on a new truck, scheduled my surgery and bypassed all the insurance BS. I had a painless, complication-free recovery, I've lost 100 pounds and and I am easily maintaining 10 pounds below my personal goal. Yesterday was my 1 year surgiversary and I'm actually glad insurance did not cover my surgery....who knows how long I would have had to wait for a surgery date. And I couldn't be happier driving around in my 15 year old truck!

Edited December 21, 2014 by Kindle

[meganrae<3 14]

@@Elode I'm so jealous! lol well cross your fingers for me! I wish I would have pursued this years go, I've always wanted WLS, but forever thought my only 2 options were the bypass or lapband. Malnutrition and device complications were nothing I wanted to get involved in, so I steered clear of actually considering it. It was only recently that I found out about VSG and I knew it was perfect for me. Now it's just a matter of making it happen:)

@@della street Obamacare sure does cover WLS here, but everything I'm reading says there's a 2 year waiting list. I'd go completely bananas! So I found a good insurance plan that covers WLS, I just have to ask for a more detailed document on what it entails. It looks good though, it's a pricey premium, but the max out of pocket is only 2,000! so it will pay for itself. I just don't want to start paying for it just to find out it has sneaky fine print that would exclude me from qualifying.

@@Kindle As soon as I found out my insurance wouldn't cover WLS I started doing my research on Mexico, I'm absolutely determined to make this surgery happen. Now my only worry about that is, I'm a cosmetology student. As of now I have like 8 dollars and a gum wrapper to my name, but I found out that I'm eligible to take out school loans. I'm completely ok with paying for WLS with school loans because it's the cheapest interest rate i'm going to find, and I know it's worth the investment. I'm only able to take out 7,000. All the mexico stuff I've been reading up on the costs roughly that much, which leaves no room for error. This whole part of the process is really nail-biting for me. I think there should be a job for this! Someone who helps step by step through all this and knows what to do. As bad as I want to get the ball rolling with this, I'm also really scared to make a wrong move. eeek

[della street 213]

@@meganrae<3 Yep, beware the sneaky fine print -- what I found out is that 'grandfathered' BCBS policies here in AZ cover band, bypass and sleeve (these would be 'older' policies in force before Affordable Care Act). Non-grandfathered policies, ie - new policies like mine..., for BCBS of AZ anyway, only cover band and bypass--they specifically exclude sleeve. So be sure to check on that as well - good luck!

[Elode 8,093]

@@meganrae<3 I will keep my fingers crossed!

[Miss Mac 6,261]

My insurance is BCBS Federal which is the best insurance I have ever had ....ever. Maybe you could get a federal job - not kidding.

Even if you got insurance that requires a pre-op supervised diet, those 3-6 months provide a valuable learning curve. You develop your new habits before the surgery, which makes it easier to be successful.

[meganrae<3 14]

@@Miss Mac I live in a painfully tiny town where people are having knife fights over burger flipping positions (not literally, but finding a job, even just retail, is really hard. let alone a government job.) and I have another almost 4 months of full-time school, which really puts a damper on my availability. Maybe I should just force marriage on some innocent federal worker. haha

[Kindle 8,667]

@@Miss Mac I live in a painfully tiny town where people are having knife fights over burger flipping positions (not literally, but finding a job, even just retail, is really hard. let alone a government job.) and I have another almost 4 months of full-time school, which really puts a damper on my availability. Maybe I should just force marriage on some innocent federal worker. haha

I've got a friend who lives in Florida, works for NOAA and has great federal government insurance. She's never paid a penny for all of her Lapband stuff, including emergency removal when it slipped, replacement and dozens of fills and unfills. When they made gay marriage legal in Florida we joked about getting married so I could get on her insurance. That was Plan C...glad my Plan B (Mexico) worked out!

[meganrae<3 14]

@@Kindle hahaha!

well, I started to really fall in love with a certain insurance company I found. They say they cover bariatric surgery, but I got too excited too quick. I then read they only cover gastric bypass and the lap band . On to the next one! I'm really considering just doing self pay in either vegas or texas, since they both have the most inexpensive costs closest to me. and its only going to be 2- mayyyyybe 3 thousand more than Mexico, and alot less hassle and wait time than insurance. It's so worth the investment.