Sad, Mad and Disappointed

[Ky.hen 5]

My insurance cord. just called me and said my insurance would only pay for a lapband or bypass. They said if I wanted the sleeve I would have to be self pay.

I am so sad and disappointed I could cry.

She wants me to talk to the surgeon about it when I go for a visit before I decide what to do.

I will have to pay alot of money at the visit.

$250 consult

$500 program fee

$295 for Phych Eval.

:tongue_smilie: Judy

[Ky.hen 5]

I called back for more info. and was told it wouldn"t do any good for an appeal. They have been down this road before with this ins. company and other patients.

Total cost would be

Central Baptist in Lexington, KY -$16750.

Georgetown, KY - $14850

:tongue_smilie:Judy

[burnsun 27]

I am sorry. The lap band was not covered 5 years ago due to the investigational issue..... could they do it as the first step to ds and just forget the rest......if you are heavy enough? If your ins company might cover that?

I really am sorry.....I know how hard it it was when I was told I could not ge tthe band...... so off to Mexico I went. Had they had the sleeve as an option five years ago....I would have skipped the band...... but other than the last 3 months of my pregnancy I never had issues and I did love my band!

[WASaBubbleButt 41]

My insurance cord. just called me and said my insurance would only pay for a lapband or bypass. They said if I wanted the sleeve I would have to be self pay.

I am so sad and disappointed I could cry.

She wants me to talk to the surgeon about it when I go for a visit before I decide what to do.

I will have to pay alot of money at the visit.

$250 consult

$500 program fee

$295 for Phych Eval.

:tongue_smilie: Judy

Can you tell them you are willing to pay the consult but you aren't sure you want surgery just yet so you can't pay for a psych eval and program fee? At least you can talk to your surgeon and just take this one step at a time?

[Oregondaisy 2,019]

Are you considering going to Mexico to Dr. Aceves to get the sleeve or just live with the ins. company's decision and get the band? I heard Dr. Aceves is running a special for a lower price.

[BeardedItalian48 3]

The doctor in Mexico Dr Aceves is a GREAt DOCTOR!

[Tiffykins 672]

I'm really sorry to hear this news Judy. I'll be keeping you in my thoughts during this process. I can only imagine how frustrated you are about this news.

[Ruthi 60]

Wow 250.00 for a consult is steep enough. What would your deductable be?

[MacMadame 81]

Actually, lots of places charge more! My surgeon charges $395 which is *low* for this area, believe it or not.

Anyway, what insurance company do you have? If you have BCBS of CA (Anthem?) or UHC, then I would agree with the surgeon's office flat out. Those guys are butheads about the sleeve! But not all of them are and many will give it to you on appeal, it just depends.

[Ky.hen 5]

Thanks for the support everyone. I was told at first that the sleeve was covered and now this. I have decided to talk to the Surgeon (Dr Oldham) first. Then I will decide what to do.

No I really don't want the band.

On top of all that, I had to see the RA specialist today. He gave me a steriod shot in my shoulder and put me on steroids for 12 days. He then said they will make you very hungry. LOL Like that is going to matter right now.

Thanks, Beard, I will think about Dr. A if all else fails.

Hugs Everybody, Judy

[Ky.hen 5]

I have Humana PPO and the deductible is $250. The insurance dosen't cover the consult or program fee. Judy

[WASaBubbleButt 41]

Thanks for the support everyone. I was told at first that the sleeve was covered and now this. I have decided to talk to the Surgeon (Dr Oldham) first. Then I will decide what to do.

No I really don't want the band.

On top of all that, I had to see the RA specialist today. He gave me a steriod shot in my shoulder and put me on steroids for 12 days. He then said they will make you very hungry. LOL Like that is going to matter right now.

Thanks, Beard, I will think about Dr. A if all else fails.

Hugs Everybody, Judy

Shoulder injections... they work soooo well! I love my sports MD! ;o) Oral steroids, I can't take them. I turn into a.... not nice person. I mean REALLY NOT NICE at all! Mood swings, all of it.

Don't be surprised if you are *really* thirsty too!

[Norma 10]

Judy,

I went to a local doctor Dr. Malley in KS for consult after attending his seminar for lapband. I told him that if I couldn't get financing that I would not afford to be able to have surgery as a self pay. He agreed that he would refund the money for the consult if he did not do the surgery. I was turned down for financing through the company that does his financing and started looking into Mexico doctors. He refunded the consult fee but he suggested some doctors and through that I have found Dr. Aceves. I am still looking for the $9500. I know the anger and disappointment, but it is your body and your life. Don't let some insurance company :cursing:convince you to do a procedure that you are not 100% comfortable with. I will keep you in my thought and send positive energy to you. We will both get our surgeries done. I know it! Ask your doc for a refund of the consult fee if you can't have the surgery done with him.

[Ky.hen 5]

Thank you Norma for your input on this. You are so right about this being our own body and having the right to choose what we want done to it. I have my heart set on the sleeve and I'm going to stick to my decision. I know that it will work out.

I hope that things will work out for you too. Have you thought about applying for a loan at the bank?

Keep me posted on how it's going for you. Judy

[Norma 10]

I haven't tried a loan yet because I know my credit is not good. I might try that in another couple of months, but want to see what I can do with Medical Flex Spending account next term (Oct) and how much I can save since I moved in with friends and cut monthly expenses first. I haven't lived with anyone in 32 years (since high school) :blink:so I am getting adjusted to having housemates right now. So far it has been great (6 weeks now). I am positive that I will find a way to get this surgery. I can not afford not to.

Edited July 3, 2009 by Norma