I do not qualify for GS because I don't have a major co-morbidity but do have a BMI of 36. I am desperate for help so am looking at Mexico as an option. How long does it take to have surgery scheduled? Do they have as many hoops to jump through as in the states? Is it a faster process in Mexico? Thank you for any insight you can provide.

Did you try through your insurance?

thats the requirements of my insurance too, and I didn t have the co morbidities. I was able to get approved bc my doctor said it was medically necessary. I've got hip/joint pain. I do have sleep apnea, but listed as mild at the worst. My BMI was 37

Thank you so much for replying! Was it your primary care doctor that said it was medically nessessary or the bariatric surgeon? I do have insurance - Tricare Prime through the military. The military doctor submitted referral to the weight loss clinic but the clinic won't even see me because they said insurance won't cover it. The only suggestion the receptionist had was to gain 20 lbs so I'd qualify. I sure don't want to do that because not only do you have to gain it but she stated I'd have to maintain it for 4 months. I feel so poorly already; I can't imagine putting on more weight!

I had tricare prime too. have you had a sleep study done? I would suggest that. Do you snore at night? Sleep apnea is a co morbidity and most obese patients have this issue. Hope this helps.

11 hours ago, Mrsa said:

Thank you so much for replying! Was it your primary care doctor that said it was medically nessessary or the bariatric surgeon? I do have insurance - Tricare Prime through the military. The military doctor submitted referral to the weight loss clinic but the clinic won't even see me because they said insurance won't cover it. The only suggestion the receptionist had was to gain 20 lbs so I'd qualify. I sure don't want to do that because not only do you have to gain it but she stated I'd have to maintain it for 4 months. I feel so poorly already; I can't imagine putting on more weight!

My initial plan was Mexico. But I figured why not try and see what happens??

I didn't need a referral, so I was able to go directly to the bariatric practice. I have low blood pressure, great blood work and a healthy heart. I was desperate and thought only severe sleep apnea would qualify me, but I only had a mild case.

My insurance company said if the doctor (bariatric) wrote a letter stating it was medically necessary, it could be covered. I didn't see the letter, but I have knee and hip pain, some back pain too. Most of my complaints were orthopedic and maybe that with the mild sleep apnea did the trick?

im thinking logically, a hip and knee replacement is more money and more recovery with PT. So it's likely in the best interest of insurance to cover this...plus it's preventative. My family has a history of high BP, heart problems and diabetes. Why wait until those develop.

I would NOT gain weight! I was so miserable at my weight to begin with, that the thought of adding any more was terrible. Then maintain it?? Probably some skinny person who has never struggled with weight thinks that's great advice. Plus you usually lose 65% of your excess weight (I know the stats may be different, but that's what my doc told me).

Tey foe the sleep study. Make sure they know if you have aches or pains. Or any rashes from the excess fat/skin.

Good luck.

Thank you so much for your reply and guidance. In order to get a sleep study, did you have to jump through hoops or just request one? I'm just surprised the bariatric center wouldn't even see me; I was hoping they could help me find a loophole or way to go ahead with a treatment. Tricare granted 4 visits so just can't believe they wouldn't even schedule a visit. I'm in a desperate place that I've not experienced before. Again, thank you for your help.

Just get a referral from your pcm. Tell them you don't feel rested when you wake up. Is there another bariatric surgeon you can see? If so, then just call tricare and change the physician on the referral.

Usually signs of sleep apnea are snoring and stopping breathing when sleeping (spouse or friend may tell you if they notice). Sometimes I would wake up sort of gasping for air.

Other signs are felling tired all the time (that was mentioned above), falling asleep every time you sit Dow to read or watch a show or Movie. Restless leg syndrome are somehow correlated with it too- according to my pulmonologist.

Maybe look into a different practice. My bariatric practice saw me and they had in house pulmonary, endoscope, psychologist & cardio docs. I did that all on my own bc I could get it done quicker by me. I was able to get my surgery done in less then 2 months from my initial visit....meanwhile I was going to Mexico bc I didn't think I would qualify. Crazy.

I hope you find a way. I felt the same as you and it's like once I decided this was the route I was taking, I wanted it DONE.

Yes! Thank you! That's exactly it. I'm grasping at everything I can. Thank you for the advice. I'm so shocked to hear you got it all done in 2 months! When I talked to the receptionist at the bariatric center, she told me IF I gained the 20 lbs, the earliest appointment right now is in June. After that, I would have to see a nutritionist for 4 months before final approval. She said expect it to take a year. I felt so defeated! Y'all are giving me hope to not give up. I am going to try to schedule a sleep study as I know my snoring has gotten worse. Again, thank you for your advice and words of encouragement.

7 hours ago, VSG4Mag said:

My initial plan was Mexico. But I figured why not try and see what happens??

I didn't need a referral, so I was able to go directly to the bariatric practice. I have low blood pressure, great blood work and a healthy heart. I was desperate and thought only severe sleep apnea would qualify me, but I only had a mild case.

My insurance company said if the doctor (bariatric) wrote a letter stating it was medically necessary, it could be covered. I didn't see the letter, but I have knee and hip pain, some back pain too. Most of my complaints were orthopedic and maybe that with the mild sleep apnea did the trick?

im thinking logically, a hip and knee replacement is more money and more recovery with PT. So it's likely in the best interest of insurance to cover this...plus it's preventative. My family has a history of high BP, heart problems and diabetes. Why wait until those develop.

I would NOT gain weight! I was so miserable at my weight to begin with, that the thought of adding any more was terrible. Then maintain it?? Probably some skinny person who has never struggled with weight thinks that's great advice. Plus you usually lose 65% of your excess weight (I know the stats may be different, but that's what my doc told me).

Tey foe the sleep study. Make sure they know if you have aches or pains. Or any rashes from the excess fat/skin.

Good luck.

Thank you so much! You've given me a glimpse of hope. I am going to pursue that. I really appreciate your help!

I did not qualify either. I went to Mexico and had a wonderful experience. It only took me a few weeks to get it done once I did my research and scheduled appointment. Good Luck!!

15 minutes ago, Mississippi Girl said:

I did not qualify either. I went to Mexico and had a wonderful experience. It only took me a few weeks to get it done once I did my research and scheduled appointment. Good Luck!!

I had read and watched many videos on Mexico and was totally ready to go. Before persuing that, I figured why not give it a go with insurance? That way at least I can say I tried, and obviously it will be no money out of pocket

I really thought Mexico was where I'd end up. I've heard a lot of good things.

2 hours ago, Mrsa said:

Yes! Thank you! That's exactly it. I'm grasping at everything I can. Thank you for the advice. I'm so shocked to hear you got it all done in 2 months! When I talked to the receptionist at the bariatric center, she told me IF I gained the 20 lbs, the earliest appointment right now is in June. After that, I would have to see a nutritionist for 4 months before final approval. She said expect it to take a year. I felt so defeated! Y'all are giving me hope to not give up. I am going to try to schedule a sleep study as I know my snoring has gotten worse. Again, thank you for your advice and words of encouragement.

Where are you located? Maybe there is a different bariatric group you could try?

2 months is not normal. I think they were a little shocked when in just over 2 weeks I had done the endoscope, cardiologist, Pulmonologist, psych, nutritionist and sleep study. I had just had a full work up by my primary doctor and they accepted those blood tests. I literally left my first appointment and made most of the appointments right in the parking lot. I got lucky because I was able to get into those docs so quickly.

The hardest one for me was psych bc there is a long list from my insurance company, but NOBODY seemed to do bariatric clearances. I literally called 20+. I finally called a local bariatric group (mine is an hour + away) and they were able to give me a name.

I have tricare south prime and was one month from consultation to surgery. I did not have to do a psych consult or a nutritionist (the docs office had one and so did the hospital). My BMI was 40 and it fluctuated.

19 minutes ago, VSG4Mag said:

Where are you located? Maybe there is a different bariatric group you could try?

2 months is not normal. I think they were a little shocked when in just over 2 weeks I had done the endoscope, cardiologist, Pulmonologist, psych, nutritionist and sleep study. I had just had a full work up by my primary doctor and they accepted those blood tests. I literally left my first appointment and made most of the appointments right in the parking lot. I got lucky because I was able to get into those docs so quickly.

The hardest one for me was psych bc there is a long list from my insurance company, but NOBODY seemed to do bariatric clearances. I literally called 20+. I finally called a local bariatric group (mine is an hour + away) and they were able to give me a name.

I'm in the Panhandle of Florida. I checked and there are only 2 insurance approved doctors in my area and they are both in the same practice. Maybe I'll look into other areas that are just a few hours away. I did message my PCM about a sleep study. Thanks for the help. I am so hopeful.

Just now, Mrsa said:

I'm in the Panhandle of Florida. I checked and there are only 2 insurance approved doctors in my area and they are both in the same practice. Maybe I'll look into other areas that are just a few hours away. I did message my PCM about a sleep study. Thanks for the help. I am so hopeful.

Ok! I hope that works out.

Keep in mind too, that some insurance requires 6 months of weigh ins. Maybe keep up with that through your primary doctor so that doesn't hold you up.

If your insurance covers a nutritionist, see if you can get an appointment with one that will go over the pre and post bariatric diet requirements. That will knock on thing out that the bariatric group will likely need you to do. Plus it is very informative and educating. And maybe find a psych doctor/therapist ahead of time too so you can set it up more easily.

My practice DID have everything in house, but many of them were not covered by insurance and I'd have to pay out of pocket a couple of hundred for each. Also, they were very backed up and appointments were tough to schedule for me.

I'm excited for you. I was you just last week. ?