Thinking about giving up...

[brittu 42]

So I'm thinking about giving up on my insurance fight and just switching to self-pay. I had a slipped band over a year ago. It took 6 months to get the insurance company (Fed BCBS) to finally agree to remove the band but they denied a revision to VSG stating it wasn't medically necessary because my BMI was under 35. I submitted an appeal to the Federal Office of Personnel Management in October for what was supposed to be a 60 day appeal. They "lost" my case and had to start over. Then they closed it because they didn't understand I was asking for a revision and not some sort of random partial gastrectomy. They finally sent it out for review but it sounds like they didn't select a bariatric surgeon because the answer last week came back that it isn't medically necessary because my weight isn't over a 40 BMI. The told my attorney to wait for the report and then call and talk to the nurse but I haven't heard back yet. At this point it's been almost 7 months since I submitted the appeal.

This has been going on for so long I'm almost back to my original weight. If I had it to do over again I'd have done a self-pay revision with Dr. Aceves right from the start. Heck, I'd be at my goal weight by now.

I just don't have it in me to keep this up. I went ahead and requested a surgery date with Dr. Aceves and put first-class airline tickets on hold on my miles. I can't think what hoops the insurance company would have next. They just don't get that the standard of care for a revision doesn't require you to regain all your weight first. I could go forward with the surgery and then sue them after the fact but I'm not sure it's worth the mental energy after all this.

I had some old Microsoft stock lying around and it's almost enough for the surgery. I'm thinking that I'll never miss the money and can just get on with my life. I don't want to self-pay up here because it's really expensive and they don't cover complications like Dr. Aceves does. I could be down there next weekend having this done and just moving on.

Thoughts? I could use some additional input...

Thanks!

Britt

[pnw218 14]

I am not big on hoops either! I took one look at my insurance info and promptly booked a date via cash as well : )

Good Luck!

[Tiffykins 672]

I don't blame you one bit. The hoops that insurance throw at people are all b.s.

I'll keep you in my thoughts, and let us know how everything goes.

[Oregondaisy 2,019]

Go to Dr. Aceves. You won't regret it. He is so wonderful and living with the sleeve is effortless compared to living with a band!

[Swiftflow 6]

I was presented with the option of doing a 6 month supervised diet and hoping my insurance would no longer consider the VSG "experimental" or apealing etc etc. I went for the self pay. In 6 months I hope to be close to my goal as possible and on with living-- Honestly there is no better investment than your health.

[educationrulz 18]

Britt,

We certainly can't tell you what to do with your money, but I can see why you're at the point of just paying yourself. I'm at the end of my 6 months of insurance hoops and for the last month I have felt like running off and getting self-pay WLS. The waiting can be a bit much at times. I can't imagine how agonizing it is when you've seen alot of your weight creep back AND you still don't have any answer from insurance.

Although I think I'm pretty good to go with my insurance approval, I told myself yesterday that if they denied me for some odd reason, I won't waste a minute on an appeal. I'm going to find some money and pay for it myself. They probably intended for you to just give up the fight if they made you wait long enough but you can't spend too much time thinking about stuff like that. It sounds like you've suffered long enough...

[thinoneday 445]

So I'm thinking about giving up on my insurance fight and just switching to self-pay. I had a slipped band over a year ago. It took 6 months to get the insurance company (Fed BCBS) to finally agree to remove the band but they denied a revision to VSG stating it wasn't medically necessary because my BMI was under 35. I submitted an appeal to the Federal Office of Personnel Management in October for what was supposed to be a 60 day appeal. They "lost" my case and had to start over. Then they closed it because they didn't understand I was asking for a revision and not some sort of random partial gastrectomy. They finally sent it out for review but it sounds like they didn't select a bariatric surgeon because the answer last week came back that it isn't medically necessary because my weight isn't over a 40 BMI. The told my attorney to wait for the report and then call and talk to the nurse but I haven't heard back yet. At this point it's been almost 7 months since I submitted the appeal.

This has been going on for so long I'm almost back to my original weight. If I had it to do over again I'd have done a self-pay revision with Dr. Aceves right from the start. Heck, I'd be at my goal weight by now.

I just don't have it in me to keep this up. I went ahead and requested a surgery date with Dr. Aceves and put first-class airline tickets on hold on my miles. I can't think what hoops the insurance company would have next. They just don't get that the standard of care for a revision doesn't require you to regain all your weight first. I could go forward with the surgery and then sue them after the fact but I'm not sure it's worth the mental energy after all this.

I had some old Microsoft stock lying around and it's almost enough for the surgery. I'm thinking that I'll never miss the money and can just get on with my life. I don't want to self-pay up here because it's really expensive and they don't cover complications like Dr. Aceves does. I could be down there next weekend having this done and just moving on.

Thoughts? I could use some additional input...

Thanks!

Britt

Bless your heart! I refused to jump through the loops and be a puppet with the insurance company. I was self pay and got a really good rate through a loan through the bank. At 3.2% i couldn't resist. It went really fast too. I started the process in October (seminar) and had my surgery said and done December 29, 2009. Much better then dealing with stupid insurance company. Good luck!

[MidwestGirl 8]

Wow, Britt. Sorry to hear that you are getting the runaround! I'm kind of surprised that BCBS Federal is doing this to you, as I had the same insurance. Mine was not revision, but my approval was very quick. I hope you figure things out soon. Best of luck.

[Maddie 9]

Sorry for the pain in the butt by the ins company. I really hope they come through for you. I am having to self pay. It's a big thing, because we don't have much money. But, this weight is contributing to many of my current health issues. So, it's not really an option from where I sit.

[ouroborous 519]

The insurance companies pretty much count on people giving up (or dying, to be honest). It's unethical, unfair, borderline illegal -- and just the way the system works.

I did a self-pay. It was a guy-wrenching chunk of money to pay out of pocket, but I'm gambling that in the long term, the health benefits of weight loss and other things (cheaper food budget!) will even out.

[brittu 42]

Thanks everyone, for your good input. I'm hoping the attorney will call me with news one way or the other and I can move ahead. I've left another message for them today.

ouroborous, how did you reconcile the risk of complications? I wanted to have my surgery with Dr. Billing at the same clinic you went to but Amber (their insurance person) tells me that complications aren't covered. Even if I could get a reasonable price for the surgery, I just can't risk catastrophic costs if I had a leak or other serious complication.

Britt

[ouroborous 519]

ouroborous, how did you reconcile the risk of complications? I wanted to have my surgery with Dr. Billing at the same clinic you went to but Amber (their insurance person) tells me that complications aren't covered. Even if I could get a reasonable price for the surgery, I just can't risk catastrophic costs if I had a leak or other serious complication.

Britt

Well, I just ran the numbers. The odds of serious complications are extremely low; leaks are 1% or less, and infections are even lower.

Dr. Billing and Dr. Landerholm are both EXCELLENT surgeons. Dr. B did a sleeve and hiatal hernia repair on my girlfriend in the same operation with zero complications, and Dr. L did a straight sleeve on me with zero complications.

If you're really worried, you have to budget more -- I think a 5-10 thousand dollar cushion would be sufficient. But honestly, the odds of this are so low -- especially if you comply with ALL of the doctor's orders, including the pre-op diet, to the letter -- that I just didn't worry too much about it.