mmcclure

Hi, Are you going with Dr. Macik? If you are, Tiffany will tell you everything you need to get done before she submits the paperwork to Cigna. Some of the insurance companies have bariatric coordinators to help you with the approval process as well. If you haven't already done so, you will need to attend a information seminar (a couple of hours) on WLS. If you go to his website, I think they list when those are held. Good luck!

Just a quick note - the Wellbutrin generic you are talking about also comes in a 150 mg dosage that is MUCH smaller. Could you perhaps take two of those? Just have your doctor prescribe two of them and get 60 at one time for a month. If you have a co-pay, it will be the same. As a matter of fact, some of the insurance companies actually advocate for this.

To Jenni80 - actually, it wasn't your post that upset me all that much. It was much much earlier in the whole thread. I do appreciate your apology and good wishes, however. It takes courage to apologize and I really commend and thank you for it. Thank you also to Swiftflow and Tiffykins for your kind words. I do appreciate the kindness and support that is shown in other areas of this forum. As I am sure all of you know, this decision is so very hard to make in the first place, and then to go through it is another huge emotional and physical process. It just concerns me when I see attacks like this, for whatever reason. I've been on other boards before so I'm not totally ignorant of how some people can be, but I guess I just thought that people here would be a bit more understanding and tolerant. I don't know why I thought that way, but I did. Anyway, I got it all out and feel much better now. :-) I hope to become "friends" with a lot of you in the coming months. I'm sure I will be on here asking for both advice and emotional support and it is really good to know that there are good people on here who care. Thanks again.

First of all, let me preface this by saying that I have not had surgery yet but, if I hadn't been able to get my insurance to pay for at least part of it, I would probably be going to Mexico to get it done. However, that isn't what I am about to address. What I would like to speak about is the fact that people are being way too judgmental, nasty and mean to people who are giving their opinions. I do not understand why it is necessary for someone to attack another person on this list when simply responding with your own opinion and/or facts would be sufficient. And, before you write back saying that you have tried that - I don't care. Try again. Do you really need to stoop to hurting people or starting a fight over something? I do not know the history that people may have together or perhaps ill feelings they may have towards one another. All I (and other newbies) see is judgmental posturing that is either backed-up or egged on by others or others attacking them in response. Who cares if someone says that they wouldn't go to a Mexican doctor? Those of you who react so strongly to statements such as this insult the rest of us who are quite capable of making up our own minds and doing our own research. True, we came here for information; however, I am more inclined to listen to someone's advice if I do NOT see them attack someone else in another post, no matter what the subject matter is. By mocking someone or downright insulting them, you make me feel like getting off of here before I get attacked as well. Which might hurt all of us in the long run because then we can not learn from each other. None of us are responsible for other people's choices, nor do we have the obligation or right to influence that choice. We can say how we feel about OUR experience or we can state FACTS with citations to back them up. We do NOT have the right to attack others because they state what they feel. Instead of attacking the original poster, why couldn't you have responded with a post that spoke of the reasons why you WOULD go outside of the United States and then let it be? Let people decide for themselves. Let people say what they would do. You have absolutely no right to attack someone in an open forum such as this. I don't know if I will stay on this board. I really wanted to, especially since my daughter and I will be having surgery at the end of June and we could really use the support. I am sure we will have questions or issues that we would really appreciate some help dealing with. On the other hand, we have had enough mean things said to us when we were overweight. We don't need more of it from people who should understand how that feels. We are looking for trust, acceptance and kindness. Certainly not what I have seen here.

I spoke with someone who had Dr. Macik on the phone the other night. One of the things she told me was that there is no drain tube. Whoo hoo! Also, when I asked her if he overstitches, she said, "no" because there is more chance of infection, there is no need for it and it makes the bougie smaller. I'm also glad that he goes with a 40 because apparently, if the bougie is too small, there is risk of it twisting and things getting stuck. I meant to ask her if you stay one or two days in the hospital. Do either of you know? My daughter and I saw the dietitian on Friday and will get our psych evaluation tomorrow. Once those are done, we only need a few tests before we are ready for surgery. My insurance does not require pre-certification (nor do they do it). It just has to be medically necessary and my PCP is doing the letter for that. It looks like we will have our surgery at the end of June! Oh, and the dietitian gave us the packet of information for our post-surgery diets, etc. She also said that he requires a 1 week no carb diet but it consists of things like meat and veggies. We can definitely do that. :-)

Hi Mary, I am going with Dr. Macik, too. My daughter and I are in the process of getting the pre-tests done and when that is finished, we will get our surgery date. We are going to try and have it done over the summer so that she won't miss much school (in college). So - I don't have anything to say, really, in answer to your questions about Dr. Macik, other than my PCP is REALLY particular who he was going to approve for this surgery for us and he was fine with Dr. Macik. I do have the name and phone number of someone who has had it done by him and I plan on calling her soon. Do you want me to send you a private message with my phone number after I speak with her so that I can let you know what she says? I do know that he uses a 40 bougie cuz I asked him (LOL) and, when I said, "FORTY! Isn't that kind of large???" He said that it wasn't, especially since it really depends on how tightly a surgeon goes up against it and he does it close to the bougie. What progress have you made towards your surgery? Marilee

Congratulations and best of luck on your journey! You are lucky indeed to have been able to get such a quick approval.

I just looked at the Aetna site again and it still hasn't been updated. I have a doctor's appointment on April 9th and I think they are going to go ahead and start all the tests that the surgeon wants my daughter and I to have. Hopefully, when the policy is updated in mid-April, we will have already gotten a lot of the tests done and can schedule the surgery. My Aetna is a bit different than most; I don't have to get pre-certified. So, apparently, I don't have to go through the 3 or 6 month supervised diet thing. But, Aetna itself still has to cover the procedure before the insurance will pay anything. I sure wish they would hurry and get their policy updated. I can't find out how much our out-of-pocket costs will be (it is a limited insurance policy) until they have an allotted amount with the hospital for this procedure and the hospital can tell me how much it will be.

I apologize if I have offended anyone. That certainly was NOT my intention. I am just trying to be as thorough and cautious as I can. Like I said, Dr. Aceves will be my choice if I go to Mexico (I'm dealing with an insurance issue right now and whether or not they will cover the VSG and what my co-insurance amounts will be is my deciding factor). I know that there have been a lot of people on here who have given Dr. Aceves praise, as I am sure he deserves. I just wondered how anyone could truly know if something is the truth about a doctor (ie, no leaks). I didn't intend to sound as if I were giving criticism.

Just a question here - how do you know for sure that Dr. Aceves has never had a leak or complication? Is that something that you have heard or do you know this for sure? Not that I think Dr. Aceves is not telling the truth or anything, but people have told me that Mexican doctors "hide" patients with complications or deaths. I know someone who worked for a plastic surgeon here in the States and she said that they had to fix things that Mexican doctors did all the time. Granted - there are good and bad doctors everywhere, but I am a bit of a skeptic when I keep hearing that a certain doctor has never had a complication when he has supposedly done thousands of surgeries. Don't get me wrong - Dr. Aceves is my first choice if I need to go to Mexico for this surgery; I just want to make absolutely sure that things are not hidden and he is as good as everyone supposedly says he is. As a matter of fact - how do we know that his patients on here are actually patients? Just asking...

I have been haunting the Aetna website since Feb. 11th. I am using a limited insurance policy to cover the surgery through Aetna and have been going nuts trying to find out if they would cover this or not. Anyway, the surgeon's office finally spoke with the supervisor and she said that they don't require precertification so the surgeon is going to get us started (my daughter and I are having it done) and plan on doing the surgery after mid-April. We have to pay the lot amount to the surgeon, but should be able to get it reimbursed if Aetna does indeed cover the sleeve next month. I am sooooo excited. I have been afraid to get too excited because I wasn't sure how it was all going to turn out, but now that I know that there is a very good chance that it will be done, I can hardly contain myself!!! :confused1:

Thanks. I've already been in contact with Nina and Dr. Aceves will be my choice if the insurance company doesn't come through or the co-payment is too high. Both my daughter (21) and myself are doing this, so I really need to find the best doctor at the best price. I won't sacrifice care for cost, of course, but I want to look at all options as well.

For those of you that didn't go to Mexico, Is this what was billed to your insurance company or is this the self-pay amount? I'm trying to figure out what my costs will be for my 20% and deductible. Thanks!

Ok, now I am totally confused. I called the member services number on my ID card and the person there told me that our coverage is actually NOT an Aetna plan, even though it says it is an Aetna company. Because it is a different type of plan/company, they don't follow the same guidelines and rules that Aetna does. She said that it doesn't matter what type of surgery we have done, it is covered up to a certain amount, with deductibles of course. I'm afraid to be too excited about this until my surgeon's insurance coordinator calls to confirm. But, I am optimistic because this woman told me the same thing several times and even gave me a direct phone number for the provider to call to confirm. I told her that the insurance coordinator called before and was told something different and she said that, according to our file, no one has called (they keep track of every call) and that the coordinator probably called Aetna, not them. Has anyone had this kind of insurance before and used it? Even though my ID card very clearly says, "Aetna" on it, it also says, "SRC an Aetna Company."

Yes, but haven't they been doing this procedure as the first step in a two-part surgery for people with high BMIs for a long time? Seems to me that that could be used as evidence that it is safe and effective, especially since I read that a lot of those people lost enough weight that they decided not to do the second part of the surgery. This is really bumming me out. My daughter and I really want and need this surgery but can't afford to pay out-of-pocket here in the States and she is adamant about NOT going to Mexico to have it done. And, it makes me nervous when I hear about people having complications and no one willing to touch them after they have had surgery in Mexico. So depressing...

It's my understanding (could be wrong) that Aetna is going to look their bariatric surgery policy over on February 11th. Say a prayer that they approve the sleeve at that time. My daughter and I both want that surgery, as well. I don't know why it is taking so long for the insurance companies to approve it (although some of them are now) - it is cheaper, generally has less complications, better long-term results, etc. Of course, we ARE talking about insurance companies here - they always make sense, right?

I'll make sure to find out after February 11th and post it here. I think they only look at changes once a year, but I could be wrong.

Question: If you feel comfortable answering this - why did you need to have the band unfilled due to your MS? I have MS and want the sleeve but, as of right now, Aetna doesn't cover it.

I, too, have Aetna and was told that they don't cover the sleeve. However, I did some research and discovered that their bariatric surgery guidelines are supposed to be reviewed on February 11, 2010. So, keep your fingers crossed that they will come to their senses and start covering it! Geez - less risk, better results, you would think it would be a no-brainer!

I have wonderful insurance through my company. However, they will not cover bariatric surgery. However, my husband's company insurance will so we decided to switch during open enrollment. At the last minute, he was switched to part-time and has to pick up Aetna/SRC which covers the surgery but has a limited max that they will pay for everything (including doctor visits). So, I kept my insurance and he is also getting this insurance (which considers itself primary no matter what). My concern is, if there happens to be a complication, would my other insurance company cover that if they won't cover the bariatric surgery? I have this fear that, if there is a complication, the hospital fees will quickly go over what the limited insurance will cover and I will end up owing thousands of dollars, even though I have great insurance that just happens to not cover bariatric surgery. Does anyone have any experience concerning something like this? Thanks!