To Sleeve or Not to Sleeve - that is the question...

[Hetera 44]

My current employer's insurance carrier doesn't cover any bariatric surgeries. For two years, I've been after them to get on board, but it's just too expensive, they said.

I asked again a month ago if they thought there was any chance that Aetna would offer coverage for bariatrics this year. They said they really didn't think so.

A month ago, sick and tired of being on the fence for so many years about it, I decided to just withdraw $10,000 my from retirement (ouch!!) (of which I only realized $7500 due to taxes and penalties), and I paid down my outstanding bills in anticipation of being a self-pay in MX (which I would also finance).

I researched surgeons, prowled boards, viewed YouTub vlogs of other sleevers.

And finally, last Thursday, I pulled the trigger: I chose Dr. Ariel Ortiz, OCC (who had a high American profile, the lowest complication rate, operated at a Center for Excellence, and who could see me soonest). I scheduled the surgery for April 30. I submitted the down payment ($500). I bought the pre-op diet Meal Replacements and Vitamins ($240). I booked my flight from NYC ($400). And I told my employer that I would be out 2-3 weeks for surgery.

Then yesterday I get a call from HR - "We wanted to let you know asap.... we MAY be switching to an insurer that would cover bariatric surgeries. We'll know next week."

Wah-Waaahhh....

So the dilemma, if there is one: IF the company DOES switch insurers, should I cancel with OCC (and probably lose the down payment?). If I change the flight (for vacation, etc.), I will lose $200.

Also, I don't know if the new carrier would make me jump through all the old hoops that I had jumped through 3 years ago (waiting six months, etc.). I don't want to wait....

But I also don't want to finance my surgery ($6000), either, if I don't have to.

[LipstickLady 25,682]

Oh, that's a toughie. I'd ask HR how long it will be until the new company comes into effect. Most often, that renews at the beginning of the new year. January is a long way away. Most likely, you will have to jump through some hoops so add another 6 months on...

How important is getting that weight off to you? That's something only you can decide.

Good luck to you! What a dilemma!!

[Lacowgirl72 210]

I waited for a year and a half for my company to cover surgery. If I would have known how great I would feel after and the tremendous weight (literally) that has been lifted off my shoulders I would of paid for it out of pocket years ago.

[NikkiDoc 312]

If the new insurance will cover the surgery I would get it covered by insurance even if it means jumping throough the hoops again. I know that many people have down well in Mexico but having local follow-up visits and local support groups is a bonus. If you have complications it is priceless. Then I would eat the deposit and go on vacation in Mexico so you don't lose your airline tickets. If you can return the pre-op diet meals I would as each surgeon has their own preferences.

Save some of your 401K money to pay for deductibles and coinsurance. Unless the new insurance has a pretty high deductible/out of pocket you may as well have the insurance pay for it. Also while we all would like to hope we don't have complications many insurances do not cover treatment of complications of non-covered procedures.

While I understand not wanting to wait I would look at it from a financial point of view too. If you do have to wait another 6 months going to a good bariatric NUT prior to surgery can be very helpful. I went to a regular nutritionist prior to surgery for my 6 months. One of the support groups I went to had a NUT that does a lot of pre and post bariatric patients and her eating and drinking advise was different and more tailored to a bariatric patient.

I did not go to my surgeon's NUT since they are over and hour from my house and 2+ hours from my work. However my follow doctor's appointments I see their NUT at the same time. Being an hour from my surgeon is no big deal if I have complications but a plane ride away is more concerning. Some bariatric doctors don't like to work on other surgeon's patients even if they are not local.

[woo woo 872]

The other thing to consider is what might happen financially if you have any complications (especially if serious).

[JamieLogical 8,684]

I would go ahead with Ariel Ortiz and OCC, because that's exactly what I did! It was a great experience and you are looking at being sleeved in a matter of a couple of weeks, versus who know how long and how many hoops IF your insurance does end up offering it? You have the means now (I borrowed against my retirement instead of actually withdrawing), you have the date, you've already spent a chunk of the money, you've already taken the penalties from withdrawing the money... I wouldn't back out now!

[VSG77 4]

My current employer's insurance carrier doesn't cover any bariatric surgeries. For two years, I've been after them to get on board, but it's just too expensive, they said.

I asked again a month ago if they thought there was any chance that Aetna would offer coverage for bariatrics this year. They said they really didn't think so.

A month ago, sick and tired of being on the fence for so many years about it, I decided to just withdraw $10,000 my from retirement (ouch!!) (of which I only realized $7500 due to taxes and penalties), and I paid down my outstanding bills in anticipation of being a self-pay in MX (which I would also finance).

I researched surgeons, prowled boards, viewed YouTub vlogs of other sleevers.

And finally, last Thursday, I pulled the trigger: I chose Dr. Ariel Ortiz, OCC (who had a high American profile, the lowest complication rate, operated at a Center for Excellence, and who could see me soonest). I scheduled the surgery for April 30. I submitted the down payment ($500). I bought the pre-op diet Meal Replacements and Vitamins ($240). I booked my flight from NYC ($400). And I told my employer that I would be out 2-3 weeks for surgery.

Then yesterday I get a call from HR - "We wanted to let you know asap.... we MAY be switching to an insurer that would cover bariatric surgeries. We'll know next week."

Wah-Waaahhh....

So the dilemma, if there is one: IF the company DOES switch insurers, should I cancel with OCC (and probably lose the down payment?). If I change the flight (for vacation, etc.), I will lose $200.

Also, I don't know if the new carrier would make me jump through all the old hoops that I had jumped through 3 years ago (waiting six months, etc.). I don't want to wait....

But I also don't want to finance my surgery ($6000), either, if I don't have to.

[VSG77 4]

Go with the insurance. It will definitely help incase of complications. My insurance took into consideration my prior nutritionist and weight watchers visits also. So I applied for insurance for surgery. They told me that they need six months of nutritionist visits. I asked them if consultations with my physician ( every timeyou talk to him abt diet) and weight watchers will do. They said "yes" YAY! ... So my physician compiled a medical necessity letter ... I am completely healthy other then the weight... So basically he wrote that if she does not have the surgery she will be at a risk of blah blah blah ! And he also included a chart of my past two years visits and mentioned that everytime I met with him we spoke abt nutrition diet n weight... He also mentioned all the diets that I have tried.

Then my coordinatir in the surgeons office filed it ( with all the other tests) and I heard from them witin a week that I was approved. I have been approved since March... But I too scared of having the surgery so I am taking my time. I have United Healthcare as my insurance.

Hope it helps ????

[VSG77 4]

My insurance took into consideration my prior nutritionist and weight watchers visits also. So I applied for insurance for surgery. They told me that they need six months of nutritionist visits. I asked them if consultations with my physician ( every timeyou talk to him abt diet) and weight watchers will do. They said "yes" YAY! ... So my physician compiled a medical necessity letter ... I am completely healthy other then the weight... So basically he wrote that if she does not have the surgery she will be at a risk of blah blah blah ! And he also included a chart of my past two years visits and mentioned that everytime I met with him we spoke abt nutrition diet n weight... He also mentioned all the diets that I have tried.

Then my coordinatir in the surgeons office filed it ( with all the other tests) and I heard from them witin a week that I was approved. I have been approved since March... But I too scared of having the surgery so I am taking my time. I have United Healthcare as my insurance.

So maybe u can start your nutritionist visits now and get the surgery done when u have the insurance. It might help if you have any complications( hopefully you don't ????)

Hope it helps ????

[AvaFern 3,516]

I would wait to find out for sure if the surgery is covered, just because if you have to make a decision it helps to be 100% sure that the two options you are considering are actually options and in this case it didn't sound like it would hurt you at all to find out next week. Despite this though, if you've already committed to getting the sleeve in two weeks, I would go for it despite the cost. I have Aetna as private insurance and I didn't think they would cover it and I didn't feel like going through all of their requirements, so I paid for the surgery which in America was 20K and I have not regretted it. With insurance you are going to have to spend the next 6 months at least jumping through hoops and in the end they might decline you anyway. The surgeon you chose has an excellent reputation and while 6K isn't exactly cheap, the sleeve isn't free with insurance- you still have co-pays and other costs that do tend to add up to some extent and you would be sacrificing months of your life on the possibility that you would still be declined and you would ultimately have to do anyway what you are already scheduled to do now.

In terms of complications, you very likely will have none, but I bought a special insurance package that covered any potential complications for 90 days after surgery. I never needed it and it cost about a grand extra. It was called Bliss insurance, but I'm sure they have different options available from other insurers.

Time is more valuable than money. You can always make more money, but you aren't ever going to buy yourself more time. You are two weeks from surgery...pull the trigger and do it now. Saving a little bit of money on a gamble that your insurance might approve you sometime in the distant future with costs unknown seems like a less than optimal option.

[DoOverWLS 4]

What state are you in? Changes made from ACA (Obamacare) requires that insurers cover it. Google "ACA WEIGHT LOSS SURGERY" to check your state or click here http://www.bariatric-surgery-source.com/obamacare-weight-loss-surgery.html

[rara71 6]

I went to Dr. Ortiz at the OCC and it was a great experience. I have lost 59 pounds since December. I would do it all over again in a heartbeat! I feel great!

Edited April 17, 2015 by rara71

[Hetera 44]

What state are you in? Changes made from ACA (Obamacare) requires that insurers cover it. Google "ACA WEIGHT LOSS SURGERY" to check your state or click here http://www.bariatric-surgery-source.com/obamacare-weight-loss-surgery.html

I'm in NY & CT. I was told by HR that Obamacare covers it only if you have an health management organization which we don't have it my firm. Or something like that.

Edited April 23, 2015 by Hetera

[ASLEEVE4ME2015 23]

Oh, that's a toughie. I'd ask HR how long it will be until the new company comes into effect. Most often, that renews at the beginning of the new year. January is a long way away. Most likely, you will have to jump through some hoops so add another 6 months on...

How important is getting that weight off to you? That's something only you can decide.

Good luck to you! What a dilemma!!

. My employer does not do ins Jan to Dec. mine is June to June which is great because my deductible runs the same way & works out good without having to bunch appointments up or get them in I should say by the end of the year (holiday time). I sure hope that whatever ins your employer chooses has the bariatric coverage so you won't have to spend your retirement money. Best of luck to you!!!