Tough Decision

[FloridaGal1976 77]

My consultation is scheduled for next Monday to get the process started for the sleeve.

Let me back up a minute. I have severe arthritis in both my knees. I underwent a partial replacement of my left knee three years ago at the age of 37. Since then, my right knee has also become severely arthritic as well. However, I've gained about 30 pounds since having my left done, and my surgeon won't do a replacement until my BMI has gone down to 35 (I'm currently at 44). Last Tuesday I had surgery on my left knee to hopefully buy me some time to lose weight.

However, I've instead decided to take a different route and have the gastric sleeve and finally deal with my weight issue once and for all and hopefully not require replacement at all.

I planned on going through my insurance to have the surgery. My consultation is free 19th. But I'm at the point that I don't want to wait 6 to 8 months to jump through all the insurance hoops, and I'm seriously considering Dr. Illan instead.

My husband is absolutely against the Mexico idea, not because he doesn't believe that a Mexican doctor is less qualified, but because he's paranoid about travel outside of the US with all the craziness that's going on in the world.

I still want to go to Mexico. The idea of being fat longer than necessary isn't something I want to deal with, nor is the pain in my knees. I know the weight is killing my knees.

Should I just wait and let my insurance cover it? Does the pre-surgery time go by quickly? Am I just being impatient?

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[Joann454 1,329]

My concern with Mexico was what if there was a complication. Would your insurance cover it? The craziness in the world wouldn't be a valid reason for me because Tijuana isn't a hotbed of terrorist activity. If your insurance will cover any complications after the surgery I wouldn't see an issue. You will still need some tests done I'm sure.

[YeaMe 246]

I can see where you are coming from. When I finally decided something I want it done now. (Good American values). It's impossible to say what your insurance process is. You can call them and they will tell you exactly what is needed and how long it will take. My BMI was too low and if I decided to gain some weight to meet the BMI needed, I would have to go on a 9 month monitored diet first. What they refuse to acknowledge is most people are aces at losing weight, it's keeping it off that is the struggle. I decided to do self pay and within a month I had surgery. My surgeon still required appointments with nutritionist, psychologist, and a endoscopy before surgery. I ended up at the last minute having a hiatal hernia repaired at the same time and the insurance ended up paying all but $700 of the hospital, anesthesiologist and labs. I just had to pay the $700 and the surgeon fee of $5,000. The hospital still is sending me reimbursement checks still! So my out-of-pocket went from $15,500 to $5,700.

I wish you a speedy process.

[Diana_in_Philly 1,426]

@FloridaGal1976 - My knees are almost as bad as yours. I'm bone on bone in both knees - similar height - weighed more and am older. Here's why I opted for going with insurance. (First - find out what your insurance requirements are - it may not be the six to 8 months you think - call and ask to speak with a nurse manager or case manager to get the answers.)

My team required attendance at a group session (I did that end of April 2016) and had my first appointment with my surgeon on May 11, 2016. My surgery was on August 23, 2016. That was just enough time to get all the pre-op crap done - endoscopy, barium swallow, cardiology clearance, orthopedic clearance, pulmonary clearance and psych eval. All of that was required by my hospital group and not my insurance, although my insurance covered everything (except co-pays) except the psych.

HW 271.5 SW 246.9 CW170-177 fluctuating right now. So I'm somewhere between 95 and 100 pounds down in 10 months.

Pre-op - I was good for at least 1 Vicodin a day to control my knee pain along with regular cortisone shots and Synvisc for my knees. I've taken maybe 3 Vicodin since August - one was a result of running 2.5 miles without warming up well enough.

As I'm sure you've read - a sleeve is a tool. So getting your head in the right place and understanding what's going on is important. It's not a long wait and while I was impatient at the start, I'm glad I had the three or four months. I spent time learning to eat better and making peace with a number of things.

What can I do now that I couldn't before - I fence (as in en garde) about 5 hours a week. I strength train another 2 hours a week. I do pilates.

While I had the surgery to try to speed up having bilateral knee replacement, based on my last conversations with my knee surgeon, I'll be able to put them off at least another 5-7 years.

Wait it out. You'll be fine. I understand the impatience, but this is a learning process.

Good luck.

[FloridaGal1976 77]

Thank you all for the advice!

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[Mickel 24]

Howdy FloridaGal. I am going the way of cash option since I don't have any other choice. My insurance WILL NOT cover any gastric operation concerning weight loss. I have my first appointment next week with my surgeon and am looking forward to seeing what the time frame will be for me. From the bariatric seminar, I learned that here in Texas, where I am having mine done, the out of pocket costs will be somewhere between $13,500 - $14,850 in cost if I stay in Hospital only one day! If you could save money and go via insurance you would be saving a good deal I suppose. My favorite singer Amy Grant once said "Once you get enough of life behind you even the hard days are a gift. It's all a gift. I guess that's the biggest lesson. Nobody ever said it would be easy and sometimes the hardest thing in life we bring upon ourselves. But everything is for a Better and Bigger Purpose. " I always pull this quote back out because it is a great reminder when life gets you bogged down!

Best wishes and luck to you.

Mickel VSG

[kaysc 14]

I totally understand wanting to have the surgery asap, I felt the same way during my 6 month wait. But honestly, it went by so quickly. When I finally got to surgery day, I felt like it all happened so fast. And I'm so glad that they made me wait. This surgery is a tool, like others have said, not a magic fix. It takes hard work and dedication and, for me at least, the six months was really invaluable to getting myself in the right headspace and giving myself time to develop some good habits. There's a mental component to this surgery that I think a lot of people don't realize, and giving yourself that time to prepare is really helpful. If your insurance will cover the surgery, my advice is to wait and go through insurance. I think Mexico should fine from a safety standpoint, and I'm so glad that it's an option for people whose insurance doesn't cover the surgery, but in it case I would suggest not using that route. I know it sucks and it's frustrating, but I think you'll be glad for it in the end.

[B.Annie 290]

Have you had consecutive monthly weigh ins at all up until this point? Have you been a part of any weight loss groups? My wait was 3 months instead of 6 because I had already seen a doctor 3 months prior for unrelated things. It only took 2 1/2 months to submit my paperwork for approval and then 1 1/2 weeks until surgery.
Trust me when I say, although every day was slow, the process was fast and because I had so many other appointments (hoops) to jump through, there was very little stagnant waiting. Also, because of the hoops, I found out I have severe asthma that I've been so used to from having it for so long that I could have died in surgery. I've been put on 2 inhalers daily and feel a ton better now. If I had gone to Mexico, I could have died under anesthesia especially since I had an attack while coming out of it and they were prepared for a breathing treatment due to my diagnosis.
All just to say, Mexico might be quicker, but it's not better if you have insurance willing to help.


HW: 328 (02/17/17)
SW: 271 (05/24/17)
CW: 253