Kelly G

Huh - did they require you to pay the co-insurance as well? That's a lot of money to expect up front before a surgery. Between the surgeon's office and the hospital (deductible+co-insurance) they are going to want $4500! I don't have that kind of money laying around. The surgeon's office offers financing, but I'm not sure if that is to cover the whole $4500 I'd need, or only the $1000 the surgeon's office wants...

That is similar to what I am talking about, nuchnuch. The surgeon's office wants $1000 before the surgery which is supposed to cover things the insurance company won't cover (the pre-surgery testing, surgeon consult, psych eval and post-op check ups for 2 wks, 6 wks, 3 month, 6 month and 1 yr). But what confuses me is the surgeon's office also telling me that the hospital where the surgery is performed is going to want my insurance deductible and co-insurance money before the surgery as well. I have just never heard of that and was wondering if anyone else had experienced that...

TBC - that must have felt frustrating (having them take so long just to submit the paperwork). I hope that's not how long it always takes them! I'm really hoping to have this surgery sooner rather than later. I am at a BMI over 50 so my insurance does not require me to do the 6 month waiting period, but I will still have the psych eval and other consults/appointments first, I'm sure. So I'm not really sure yet when I'm hoping to have the surgery. ASAP, I guess! I hope you get your surgery date, soon!! How do you like Dr. Foote? Dr. Kemmeter was who did the seminar I attended and I really liked him, but I've also heard really great things about Dr. Foote!

Thanks for replying, MMOL! I work at a hospital, which makes my insurance really wonky. I technically have 3 "tiers" of "in-network" insurance. Tier 1 includes the hospital I work at (so surgeries that happen at the hospital where I work gets more coverage from my insurance), tier 2 includes some doctors who don't work at the hospital where I work, but are in the area, and teir 3 covers any doctor or hospital services that accept blue care network insurance. So the surgeon I would like to do my sleeve is in the blue care network, but he doesn't work at the hospital where I work. So I will get coverage, but not as much as if he worked and performed the surgery where I work. Does that make sense? Of course it doesn't, it's health insurance, haha. So I've already checked with my insurance company, and they say that the surgeon and the hospital where I'd like to have it done are both "in network" as far as accepting blue care network insurance. However on the sheet I got at the seminar today, it says (and I quote), "Saint Mary's will require payment in full prior to surgery for any coinsurance or deductibles." So even though Saint Mary's is "in network" and accepts my insurance, I am reading that quote to mean that they require me to pay the consurance amount and deductible amount BEFORE I get the surgery...which confuses me!

I am just starting this journey, but plan on having my sleeve done by Dr. Kemmeter or Dr. Foote at Grand Health Partners. Unsure yet if I will be having it done at Spectrum or St. Mary's. Unsure if I decide where it's done or if which surgeon I pick decides where I'll have it done. But I'd prefer St. Mary's!!

I also have BCBS Michigan and was told that because my BMI is over 50 that it basically waives the 6 month supervised weight loss program requirement. She didn't mention whether or not it waived the other pre-requisites for surgery (psych eval, etc). But said that basically after the submittal it wouldn't be very long at all for the approval, and then any day after that I could have the surgery. But seeing as I only just today went to the seminar and yesterday my PCP sent over my referral to the surgeon, I think I still have awhile until my submittal for approval would be ready to send it!

I haven't been sleeved (yet), so I can't really answer if I've also struggled with it. But I just wanted to show you some support and let you know that 50 lbs lost is a HUGE accomplishment!! It might not be where you want to be at your goal, but it is a huge step in that direction and you should be proud of it!! It's so sad and frustrating when people are malicious for no reason, but don't let that get you down on 50 lbs of weight lost! That's a huge bag of dog food worth of fat - GONE. Be proud - hold your head up high, girl!! --Kelly

Thanks, and welcome to you as well!! My biggest worry is the money aspect of it (I'm sure I'm not alone in that!). After insurance I am going to have to pay around $5500 (my annual insurance deductible + co-insurance out of pocket maxiumum). And if I am understanding the literature from the seminar correctly, I am going to have to pay that up front before the surgery takes place. Yikes!! I'm going to have to finance that somehow!!

Hi everyone! I'm Kelly I have been debating WLS for about two years. Which is kind of funny because in those two years I have gained another 50 lbs! I recently moved for a new job and started seeing a new doctor. We obviously started talking about my weight and he asked me what I have been trying as far as losing weight. I told him all of the many (MANY) attempts at WW, Atkins, every diet you could name. The gym memberships. The hours killing myself at the gym. All to lose a total of 5-10 lbs and then just stop losing altogether. Then I'd get down on myself and give up on the diet saying it wouldn't work. Or stop going to the gym since it didn't do anything anyway. Then he asked me to count the calories I eat in a day for a week. Not with the expectation of cutting calories, but to just see how much I eat. And it was astonishing! I would once look at my plate and think "OH that's not that much food" but when you actually start measuring it out...wow. So after taking this findings to my doctor, and he agreed that my problem is not the dieting, and not the exercise, but just the being hungry all the time and over-eating. Over though I'm not having huge meals, I'm just eating too much, too often. He suggested going to a seminar of this surgeon that he sends all of his WLS patients. I'm going to that today! I'm really excited to start this journey. But I'm also scared about how long I will have to be off of work after the surgery. I have only just started this job a few months ago so I haven't accumulated more than a day or two worth of vacation... I'm excited to get to know you all and go through this journey with all of you!

Thanks for replying, Nellie! I'm hoping to really become part of the community here and both get support and support others going through this process as I go along!! The seminar was really informative and really cemented my decision to get the sleeve gastrectomy. The surgeon was really nice and I would like for him to be the surgeon to do mine! Just starting on the journey and making my contact with the insurance company to get all of that mess started, lol

Hello, everyone! My name is Kelly - I'm 25 years old and weigh 330 lbs (just typing it made me cringe!). I am just beginning this journey. I made my appointment today with my PCP for May 21st to get my referral to see the bariatric surgeon. I am very nervous, but even more excited that I will finally get my weight under control! I have been heavy-set since my early teens, but played a lot of sports and stayed very active to keep my weight in check. But I downright ballooned whilst being pregnant with my son. After he was born in January 2007, I never lost the weight. But because of the weight I had gained, it was uncomfortable and painful to work out with enough intensity to lose. So then I began gaining, as well. I finally had the last straw when my husband and I went to the YMCA to walk. We walked for just 20 minutes and by the end of it my legs itched so bad (that itch on the inside from built-up fluids pooling in your legs, so scratching doesn't help - it just makes it worse) I was actually in tears. That was when I knew that I needed outside help. A gentle "push" in the right direction. A hand up out of the downward spiral that is the "gain weight so working out becomes harder, working out becomes harder so you don't work out as much, so then you gain weight" and portion control, which has always been a problem I've had. This is the "head start" I need to get my portions in control, so I can lose some weight to get started, and then get back in the gym and really get moving again!! I have no idea what lies ahead, I'm only really just starting this journey. I have no idea what to expect when I go see my PCP on the 21st. He has always pushed for the "diet and exercise" regimen, so I'm afraid if I go in asking for a referral he won't give me one and will just tell me to keep trying diet and exercise (to no avail). Then I'm afraid of what to expect from my first appointments with the surgeon. What will be the process BEFORE having the surgery? And then AFTER? So I'm hoping to read some of your stories and get a better idea for what I'm up against. But I'm finally ready to take control! And that's got to be the hardest first step there is, right?