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The easist way to break it down is you can think of surgeries like this has having three phases. 1) Deductible phase - this is where you are responsible for 100% of the allowed amount charges approved by the insurance company. 2) Co-insurance phase - this is where the insurance company helps to foot some of the bill in your case 80% of it. Most insurance companies have a co-insurance cap and after that's met... 3) Out-of-Pocket Max Phase - this is where you have satisifyed your out of pocket maximum which consists of your deductible cap and your co-insurance cap combined. Once this is achieved your insurance will begin to process at 100% of the allowed amount for the remainder of your benefit year. So what you'll want to do is when you speak to your insurance company make sure they clarify co-insurance maximum vs. their out of pocket maximum (even insurance carriers often get this confused in their verbage when quoting benefits). Here's a basic scenario to explain. Let's say you go and have a surgery and all your bills combined comes out to $22,000.00 You're benefits for insurance include a $2000.00 deductible, a co-insurance of 80/20% with a co-insurance maximum of $2000.00 - that means your out of pocket maximum would be $4000.00. So 22,000.00 minus the $2000.00 deductible leaves us with $20,000.00 20% (your responsibility of the co-insurance) leaves you oweing $4,000.00 of the $20,000.00 - BUT because we have a $2,000.00 co-insurance maximum you only pay that $2,000.00 and the insurance picks up the other $2,000.00 that would of been part of your 20%. So your out-of-pocket maximum has been met totalling $4,000.00 of the $22,000.00 bill - even if that bill was 40,000.00 you'd still only pay the $4,000.00 for in-network services rendered. Sorry for the long explination - it just really helps I think to understand how it all works at the insurance company (they definatly don't make it easy to understand up front lol). I know I wouldn't understand it if it wasn't for my loving, awesome, supportive husband who's super cool.

Thank you Cheri! That was incredibly helpful information. I'm very excited for food to become 'uninteresting' and become a back seat for me. This board has really helped with learning to be patient however and it will all take time. I wrote down Syntrax and will have to try it. Do you drink a shake daily as a Meal Replacement or in addition to your three meals? Just curious if it's an easier solution thing or just because you need the extra protein in your diet.

Thank you great idea!

Hey everyone! Just joined the boards like 2 days ago and I have been enjoying myself so much reading everything. If anything it is making me even more giddy and impatient for my surgery on July 24th. I'm so excited to begin my new life already. Every single day I think about my upcoming surgery and the future. Time needs to move faster already!! I think the thing I am looking most forward to is buying a whole new wardrobe. I trully hate shopping and have always just bought anything that fits me rather than something fashionable. Oh yes and I am a 31-year old mom to a 19-month. Only a few months ago I saw my highest weight to date at 283lbs. Scary stuff. I've been able to come down a bit to 266lbs but I'm hoping to lose another 10-15 before the surgery. It has been a long road since I decided to have surgery and finally getting a set date. There were times I thought I wouldn't be able to do it when the doctor's ordered me to take more tests. Luckily everything turned out fine. I'm also very grateful to have this new job with an amazing health plan. My final bill will be a big $0. There is no other way my broke ass would have been able to afford even a few hundred dollars! Also for my wonderful husband for supporting my decision. I'm most concerned about: - This head hunger I've been reading about. I already think about food way too much. I eat when I'm not hungry.. I even munch on things when I'm full because food is so good. I hope I have the strength to make it through the pre-op liquid diet and the post-op liquid diet. I'll just keep telling myself that it's temporary and to take it day by day. - Being able to control my food choices once I start solids again. It's really tough in my job with our catered lunches and weekly deliveries of Snacks. There is literally food and snacks every 20 feet here. But most of all carbs... ahh I could eat Pasta and bread all day. Thank you all for reading. I look forward to get to know all of you and be here for a long time. Feel free to keep in touch especially those having the surgery close to my date. Oh and if anyone has suggestions for which Protein drinks they liked the best I'd love to know. Right now I'm thinking of just doing Atkins shakes for the 2-week pre-op and then unjury or bariatricadvantage mixes after as those were recommended by my doctor.

Hello! Some notes about insurance as I am lucky enough to have a husband who's worked as an insurance specialist. Not only should the doctor you find be in-network but also make sure the hospital and anesthesiologist are covered. If they are in-network then your insurance (as you stated) will cover 80% of it. The first doctor I found was in-network, however the hospital was not so it wasn't an option. Your insurance should also have something called a maximum out-of-pocket. This means there is a maximum amount that you have to pay each calendar year for medical services. This amount on average will be $1,500-$5,000. If yours is $2,500 for example... EVEN if your surgery costs $100,000, 80% would be $20,000 left for you, you would still only pay a maximum of $2,500. I doubt you couldn't finance this cost into monthly payments either. I'm still paying off mine from a year and a half ago for having a baby! So really there should be no concern abou the actual cost of the surgery as long as the doctor, hospital and anesthesiologist are covered. Please also note that there will be additional testing you'll have to do. Most of this should be covered as well. However my insurance didn't cover the psychological evaluation I had to have. If you're in the same boat you can always find a cheaper psychologist. It took me about 6 months from the time I initially called to make my first appointment to my surgery date in the end of July. Two of these months were just waiting for the first appointment as my doctor is busy so yours may be faster.

Congrats for you. I hope for only the best. My surgery is on the 24th too

So I had always thought that mashed potatoes, one of my favorite things to eat, would have to be cut out because potatoes contain a lot of carbs. But I'm seeing a lot of people on here mentioning they eat it. Was I wrong all along?

I'm a day before you. July 24th!!! I'm so excited, this date cannot get here fast enough. I had to pass all my medical tests before I got a date. Blood tests, x-ray, ekg and upper endoscopy. I also had to do a stress test because my ekg was slightly abnormal. The Upper Endoscopy was more than I thought it would be. It's a minor surgery with gowns and IVs and operation rooms and everything. At least mine was. It wasn't bad at all but you have to take a day off work.

Good luck I was told it would take about 4 weeks for my insurance to approve the surgery but it only took them one week!! Maybe you'll have luck too.

Hey Carlos. I'm also in the San Jose area but getting my sleeve done at Stanford last week of July. I think you're doing an amazing job and you sound like a wonderful father. Don't worry, next week is July already and August will be here before you know it. I can relate to your story as my husband is also a stay at home dad to our 19-month son. He too is overweight though his BMI is not as bad as mine. He's decided to follow me though and eat what I do (just slightly more) including the 2-week liquid diet. I'm excited for both of us. Keep us updated and best of luck to you.

Like a lot of people, my weight issue is uncomfortable and embarrassing to me. My husband, parents, brother, MIL know but I have no plans to tell anyone else. I have close friends at work but all my best friends are across the coast. I have taken off time at work and will tell anyone who asks that I am just enjoying a much needed summer vacation where family is coming to visit and my brother is expecting his baby (which is all true). If anyone asks about my condition right after returning to work I will just mention my stomach has been bugging me. I've already started dieting (eating low carb/fat). I don't have a problem mentioning this fact at work that I'm trying to eat healthier and exercise more. I'll be doing the liquid diet pre-op for 2 weeks so with all this factored I don't think my behavior post-op will seem as strange. I know this sounds harsh but this is what I feel most comfortable about. If anyone compliments me, I will say "thank you very much". If they ask me how I did it I will say "I finally chose to eat healthier. Cut out fats and carbs. I'm exercising a lot". This won't be a lie becaue the surgery is a tool and it is not the surgery ALONE that will get me to my goal. Though I do believe if anyone asks me outright about having surgery I may admit it. Not mentioning a fact is one thing, but outright lying is another. Perhaps after some weight loss and a much happier me I will feel comfortable telling my best friends but for now this is my plan .

Surgery is on July 24th. I cannot wait any longer. I have one more lecture/group session on the 3rd and then preop with the surgeon and nutritionist on the 12th. Hurry up and be end of July already.