Decisions , Decisions

[geobaby 0]

:confused: I don't know what to do!!!...... I just called to make my first consultation and they want to know if I’m going to be self pay or covered by insurance. WELLL the problem is I have Cigna and like most insurance comp. they don’t cover the VSG "YET"! I have heard rumors that in January that there MIGHT be a pass and the sleeve will be accepted by most insurance. The problem is what if it doesn’t get passed and I’m in the same boat now, having to pay myself but only now i wasted 3 months?? The other dilemma is what if it is passed? I’m not even sure if they will cover me because my BMI is 37 not freakin 40! And I don’t have any health related risk (that I know of). I know Cigna says you have to have a BMI of 40 or higher or 35 with health risk cause both my parents had the gastric done. WHAT TO DO... WHAT TO DO... If I decide to wait for insurance and start preparing for it I have to start seeing a Nutritionist, if I self pay I don’t. Now my big Q: is should I start preparing myself for the insurance road or the fast but expensive road??? Please don’t tell me it’s up to me to decide because I get that. I just need to know what u might do or an idea, opinions, something! Please….:cursing::scared0::cursing:

[Chancie 65]

I took the fast more expensive road, after wasting 3 years fighting with insurance. All I can say is I wish I had done it 10 years ago.......so hope that helps!!!

[kromrider 3]

Your initial consultations should be covered either way. Mine was. Once the surgeon tries to get approval for a VSG thats when the fight starts. I was lucky they approved mine on the first try.

[cajun 46]

Here's what I did. I have Cigna too. I knew that VSG was not covered, and I knew that it MIGHT be covered by sometime in 2010. However I also knew that once they covered it, they would expect you to wait 6 MORE months while you go through all kinds of expensive tests, psych consults, physician monitored attempts at wt loss, etc, etc, etc. I did not want to wait any longer.

So I did a LOT of research and found an outstanding bariatric surgeon, Dr Alberto Aceves, in Mexicali, Mexico (who did sleeves on a lot of the members of this forum), and decided to just "get er done".

I called his coordinator and a few weeks later was "sleeved" in Mexicali, on Sept 23...almost 3 weeks ago. It was the best decision of my life, and the best $8,500 bucks I ever spent! As a nurse for over 30 years, I can assure you that the medical care I received was better than any medical care I have been given in US hospitals for the three other surgeries I have had. So far, over 30lbs lost!

It has to be your decision as you know. Just do your research, be sure your surgeon had performed over 300 of the surgery you have chosen, and that it is done in a full service hospital, not just a clinic. Read the post on "how to choose a mexican surgeon", which can be applied to any surgeon actually, not just mexican ones. It is major surgery and no surgery is without risk even with the best of surgeons. Take your time, be sure you are comfortable with your choice, and do it on your own timeline!

[tomandlu 0]

I think that the clincher will be your BMI w/no comorbidities... That might be a harder fight than getting them to cover VSG. If you can get their medical policy and find out what they consider a comorbidity - that varies widely, from type II diabetes to high cholesterol. If I had a choice between fighting insurance or going self pay - I'd go self pay ASAP!

Good luck,

Luanne

[thinoneday 445]

:smilielol5: I don't know what to do!!!...... I just called to make my first consultation and they want to know if I’m going to be self pay or covered by insurance. WELLL the problem is I have Cigna and like most insurance comp. they don’t cover the VSG "YET"! I have heard rumors that in January that there MIGHT be a pass and the sleeve will be accepted by most insurance. The problem is what if it doesn’t get passed and I’m in the same boat now, having to pay myself but only now i wasted 3 months?? The other dilemma is what if it is passed? I’m not even sure if they will cover me because my BMI is 37 not freakin 40! And I don’t have any health related risk (that I know of). I know Cigna says you have to have a BMI of 40 or higher or 35 with health risk cause both my parents had the gastric done. WHAT TO DO... WHAT TO DO... If I decide to wait for insurance and start preparing for it I have to start seeing a Nutritionist, if I self pay I don’t. Now my big Q: is should I start preparing myself for the insurance road or the fast but expensive road??? Please don’t tell me it’s up to me to decide because I get that. I just need to know what u might do or an idea, opinions, something! Please….:001_tt2::fencing::laugh0:

Well here is exactly what I did . . . SELFPAY. . . I don't have time to be a monkey for insurance and jump through their hoops and do this stupid thing and that stupid thing just so they can say they hold my life in their hands. . . I took out a personal loan for the whole amount at 3% interest payback. NOW I HAVE CONTROL over what I want and when I want it. One thing I can't stand is someone (insurance companies) telling me what to do. . .alot of the folks have had great luck with Mexicali surgeon Dr Aceves who is cheaper too. . . that might be a good route for you. . I'm getting mine done here in San Antonio, expensive I know but have no choice on that one. . hope this helps!

Edited October 14, 2009 by thinoneday

[queenborg 0]

A lady I knew was 38 bmi and was lucky enough not to have co-morbidities but of course that meant her surgery wasn't covered. She wore ankle weights under trousers. Not recommending it but just saying its silly that theres this magic cut off for 40 than say 37

For me - I got them to measure my height again and i had always put myself as 5 ft 5 when it turns out I'm just over 5 ft 3. Makes a huge difference in your BMI.

We always tend to think we are taller and weigh less than we do. In WLS doesnt pay to do either!

Best of luck - I'm hoping to do my VSG in March Please God after baby comes in January. Hopefully UHC will still be approving it then