How will this be different?

[HatheryOnHerWay 603]

Have you gone to your consult yet?

Nope, not even gonna get my hopes up until I secure financing! I'm currently in talks w/ my credit union about it. If I can't secure financing, I'm going to have to look into other options (selling my car? selling a kidney? haha)

[SqueakyWheel&Ethyl 160]

Yes, are you CERTAIN it's excluded? When I called my insurance they said it isn't covered and tried to end the call right there. But I said, "what if I'm 100 lbs overweight? Or what if I have other medical conditions that warrant it?"

They said, "you're asking us to bend the rules for you."

"No. I'm asking you what the real rules are so I can see if I qualify."

I work for a county. Before this, EVERYONE I spoke to who also worked for the county said it wasn't covered. I found out by PUSHING and demanding info in writing, that they DO cover it if:

1) Patient is 100+ lbs overweight, or

2) Patient is 80+ lbs overweight with at least two qualifying health conditions (diabetes and high blood pressure, for example).

I would double check your insurance now. They don't volunteer this information. You have to really dig for it. If they blanket exclude WLS - no exception, then that's a closed subject.

Also, where in the US can you get sleeved for $10K? It's usually double that. I see lots of folks having really good experiences doing it in Mexico for less than $5K, all travel expenses included, including hotel and airfare.

[No game 14,436]

Nope' date=' not even gonna get my hopes up until I secure financing! I'm currently in talks w/ my credit union about it. If I can't secure financing, I'm going to have to look into other options (selling my car? selling a kidney? haha)[/quote']

Well don't sell your soul! The surgery is not going anywhere!

Anyway my husband wasn't keen on the idea either. And yes he's been with me through so many (and sometimes expensive) diets that worked and then I gained the weight back.

For this I asked him to please just come to the consult to the surgeon with me, that's all. "Just lets see what they have to say"

And in that appointment all was laid out to him

(And me) he left there knowing everything, including my weight. He had been on board ever since

Oh by the way the same tactics worked for our dog and my diamond ring

[HatheryOnHerWay 603]

Yes, are you CERTAIN it's excluded? When I called my insurance they said it isn't covered and tried to end the call right there. But I said, "what if I'm 100 lbs overweight? Or what if I have other medical conditions that warrant it?"

They said, "you're asking us to bend the rules for you."

"No. I'm asking you what the real rules are so I can see if I qualify."

I work for a county. Before this, EVERYONE I spoke to who also worked for the county said it wasn't covered. I found out by PUSHING and demanding info in writing, that they DO cover it if:

1) Patient is 100+ lbs overweight, or

2) Patient is 80+ lbs overweight with at least two qualifying health conditions (diabetes and high blood pressure, for example).

I would double check your insurance now. They don't volunteer this information. You have to really dig for it. If they blanket exclude WLS - no exception, then that's a closed subject.

Also, where in the US can you get sleeved for $10K? It's usually double that. I see lots of folks having really good experiences doing it in Mexico for less than $5K, all travel expenses included, including hotel and airfare.

I'm attaching a screenshot from my insurance policy so you can see the exclusion. What do you think?

The places I've found in the US that will do it for less than $10k (or around that) would be Dr. Borland in Louisiana, Dr. Gonzalez in Texas, and Dr. Washington in South Carolina.

[SqueakyWheel&Ethyl 160]

I'd still call and question it, just to be sure. They said No on the phone to me at first, but when I pressed further, they admitted there are SOME circumstances in which they would cover it, but they were getting angry with me for painting them in a corner. It is so obvious they don't want anyone to know they do cover SOME. I'd ask, "what if you're 100 lbs overweight? What if your BMI is over 40? What if there are medical conditions and doctors advice to have it?" That's how I broke through.

If the answers are all "no" to those questions, then ask them to send you that in writing. THEN, close that door.

[SqueakyWheel&Ethyl 160]

I also learned that our insurance company's Medical Director and his nurse have annual bonuses tied into how much they can deny coverage for WLS surgery. I talked with a nurse from my secondary insurance carrier who KNOWS my primary insurance company's Medical Director (the one with final approval). She said they are nice folks, but are under pressure to block these approvals to save $$. But, they have a heart and will probably approve if everything is in place.

It was. They did.

[HatheryOnHerWay 603]

I just so happen to have a friend who work's for my insurance company, so I'm going to ask her and see if she knows of an backdoors or loopholes like that with my insurance. I have Physician's Plus (I think that might be a Wisconsin thing?) My insurance covers just about everything under the sun, but apparently they don't think fat people are worth helping. Grr.

[SqueakyWheel&Ethyl 160]

MOST insurance companies say it isn't covered, but if you have qualifying conditions, I think that sometimes they HAVE to. I'm no insurance expert, of course, but I know that there is a huge industry for bariatric surgery advertising that their expert can get your insurance to say "yes" so there must be loopholes. I went straight to my Medical Director's office and got on a first name basis with his nurse. She resisted at almost every turn. I kept asking for a step by step list to follow. She refused to cooperate, instead, choosing to give me ONE piece of info at a time, hoping one of them would trip me up. I documented everything and will blog all of their requirements (which were tedious) for others to learn from. I got mine covered, tho!!

[SqueakyWheel&Ethyl 160]

In the end, she admitted they cover up to a limit of $12,500. My surgery total will be about $18K. But, I have insurance through my husband's company that picks up the rest.

[920amy 409]

Hathery, have you looked into going to Mexico for VSG? I started looking into WLS about 2 years before I had surgery. at that time, my husbands insurance did cover WLS, but then as things go, our insurance changed, and WLS was excluded. I researched and discovered Mexico surgeons are a lot cheaper than their American counterparts. In some cases, the surgeons in Mexico have a lot more experience as well since VSG has been done for a lot longer in Mexico. I personally used Alighterme.com and had Dr. Lopez as a surgeon in Tijuana Mexico. My surgery was $4,750 that included pick up from the airport in San Diego, hotel stay at the Marriott in TJ, 2 night stay in the hospital, another 2 nights at the Marriott, all of the Jello and chicken broth at the hotel restaurant, and return trip to the airport. Surgery in Mexico isn't for everyone, but it turned out to be the best thing for me. There is a self pay/Mexico forum on here, check it out! There are many Doctors and many people who have been and are exploring Mexico as an option also. Feel free to PM me if you want more info or want to know more about my personal journey. Good Luck to you!!

[HatheryOnHerWay 603]

_{I really don't understand their resistance! It just seems like the long-term benefits for them as far as insurance payouts would be substantially less if they just paid for the surgery. I guess when I'm president, I'll change that haha}

[HatheryOnHerWay 603]

Hathery, have you looked into going to Mexico for VSG? I started looking into WLS about 2 years before I had surgery. at that time, my husbands insurance did cover WLS, but then as things go, our insurance changed, and WLS was excluded. I researched and discovered Mexico surgeons are a lot cheaper than their American counterparts. In some cases, the surgeons in Mexico have a lot more experience as well since VSG has been done for a lot longer in Mexico. I personally used Alighterme.com and had Dr. Lopez as a surgeon in Tijuana Mexico. My surgery was $4,750 that included pick up from the airport in San Diego, hotel stay at the Marriott in TJ, 2 night stay in the hospital, another 2 nights at the Marriott, all of the Jello and chicken broth at the hotel restaurant, and return trip to the airport. Surgery in Mexico isn't for everyone, but it turned out to be the best thing for me. There is a self pay/Mexico forum on here, check it out! There are many Doctors and many people who have been and are exploring Mexico as an option also. Feel free to PM me if you want more info or want to know more about my personal journey. Good Luck to you!!

I'd be more than happy to go to Mexico, but my husband is absolutely adamant that I will not be doing that. He has the idea I'd be in some back-alley chop shop with dirty medical instruments and untrained doctors. I know this is 100% untrue, but he believes what he wants to believe and really won't research anything (despite my request that he educate himself on this topic.) Since he is so resistant to begin with, I gotta take what I can get! And if he'll be ok w/ a doctor in the US, at least I get the surgery. Who knows though....we might find out we can't finance more than a few thousand, in which case Mexico may be my only option. It'll take some major convincing, but I want this surgery!

[SqueakyWheel&Ethyl 160]

I used to think that, too about going to a foreign country for surgery. But after reading all the stories here, I'm considering Mexico for Tummy Tuck and breast augmentation after I lose all the weight, because I KNOW my insurance won't cover it.

[No game 14,436]

Listen, it is written in your policy that they specifically do not cover it... While I'm happy for the woman that was able to get her a surgery it sounds like it wasn't a written exclusion in her policy...

And Mexico is a good option, but if its not something you can agree on with your husband, then it's not an option..

What I'm saying is keep it simple, you have a plan to secure financing you have your doctor of choice narrowed down ?

Just do what you are doing take it a step at a time

[SqueakyWheel&Ethyl 160]

Find the good Mexico stories on here and read them aloud to him. Just, "Hey, listen to this....." And let him "learn about it" with you.