Hi pals,

I am a 31 yr old male, 340lbs as of today and have diabetes, high blood pressure, and severe sleep apnea. My physician brought up the topic of getting bariatric surgery and how it could be helpful for someone like me. I started doing research on various surgeries, their benefits, complications, and side effects and after much research, I have made up my mind to get a gastric sleeve done. I checked with my insurance today and learned that the surgery will not be covered under my plan, which sucks due to the high costs involved but I think the costs and risks outweigh the benefits over time.

Could you pals help me get started on my journey here? I am looking to get it done sooner than later and since I will be paying out of my pocket, I am looking for some economical options stateside. Please share your experience with me, especially if you have had one done recently and the cost was a consideration in your case too.

Thank you very much!

Your pal

So..is your insurance through an employer or through other means? If employer, look into changing jobs maybe. Do you live near another state's border - perhaps you could move just over the stateline, etc. Just throwing suggestions out there. You don't give much added information.

Edited February 16, 20188 yr by Sosewsue61

Thanks for your response. Yes, my insurance is through my employer, changing jobs is not an option (just a personal thing). I live in Mass but have no problems getting the surgery done in any state within the U.S, as long as it is most economical. What else info can/should I provide? I apologize, I just started today so still learning about this website which so far seems awesome by the way.

Dr Pleatman-Michigan, Dr Borland-Louisiana, Blossom Bariatric

-Nevada, Bariatrix Florida, I've heard of these. Ohio State University -near where i live -runs$10000 to 19000 lapband being the cheapest RnY the most expensive. And one of the posters said she paid $8999 somewhere in Florida.

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In addition to recently have a sleeve myself, I also work for an insurance company. Are you sure it is completely excluded, or are there steps you need to go through? Ms y companies will pay if you try other things first. Can your Doctor argue that it is medical necessity? The results are proven, no longer debatable. Most insurance will cover over a certain BMI with other conditions. Make sure you are not just talking to the first line call center, but a case manager or someone in utilization management. It is cost effective for employers to cover these things in their policies now as it is more expensive to treat your other conditions long term. Sorry for probably too much info, just want to make sure you don’t have to pay if you don’t have to. That said, it is well worth it if you are ready to do the work. I have lost 65 pounds in the last four months, blood pressure is great and cholesterol has come down 40 points already. After 20 years of struggling with food, I finally have a tool to help me get control which has been beneficial physically, emotionally and spiritually. Just my two cents! Best wishes!

Look up Dr Borland in Louisiana, bariatrix Florida, Dr shillingford. Bariatrix Florida and Dr shillingford are around 10k in the ft Lauderdale area. Also, blossom bariatrics in Las Vegas. I used bariatrix (Dr Taggar) when they had a special rate of $8899 and have been very pleased.

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Also, look into the hernia route. If you have a hiatial hernia, some surgeons will charge insurance for the repair, and charge you a reduced cash rate like $5k for the sleeve. Dr Kim in TX advertises this, and there are quite a few who do it this way.

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On 2/15/2018 at 8:18 PM, jeaniebeanie said:

In addition to recently have a sleeve myself, I also work for an insurance company. Are you sure it is completely excluded, or are there steps you need to go through? Ms y companies will pay if you try other things first. Can your Doctor argue that it is medical necessity? The results are proven, no longer debatable. Most insurance will cover over a certain BMI with other conditions. Make sure you are not just talking to the first line call center, but a case manager or someone in utilization management. It is cost effective for employers to cover these things in their policies now as it is more expensive to treat your other conditions long term. Sorry for probably too much info, just want to make sure you don’t have to pay if you don’t have to. That said, it is well worth it if you are ready to do the work. I have lost 65 pounds in the last four months, blood pressure is great and cholesterol has come down 40 points already. After 20 years of struggling with food, I finally have a tool to help me get control which has been beneficial physically, emotionally and spiritually. Just my two cents! Best wishes!

2

That is a very good advice, I may reach out to my insurance again and even talk to a case manager.

Congrats on your great progress and keep it up.

On 2/15/2018 at 7:32 PM, kakatlady612 said:

Dr Pleatman-Michigan, Dr Borland-Louisiana, Blossom Bariatric

-Nevada, Bariatrix Florida, I've heard of these. Ohio State University -near where i live -runs$10000 to 19000 lapband being the cheapest RnY the most expensive. And one of the posters said she paid $8999 somewhere in Florida.

Sent from my VS880PP using BariatricPal App

Thank you for these suggestions. I will check them out.

13 hours ago, GassyGurl said:

Look up Dr Borland in Louisiana, bariatrix Florida, Dr shillingford. Bariatrix Florida and Dr shillingford are around 10k in the ft Lauderdale area. Also, blossom bariatrics in Las Vegas. I used bariatrix (Dr Taggar) when they had a special rate of $8899 and have been very pleased.

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Thank you very much! Few more questions based on your experience, I apologize if they sound personal and I will completely understand if you do not feel like answering some but please know it will greatly help me formulate my decision.

1. How long was the surgery and how long did you stay in the hospital?
2. How soon were you able to return to a normal schedule?
3. How soon did you start losing the weight after the surgery?

4. Has the weight loss been consistent or at least continuous since you got the surgery done?

Thank you again.

A couple ideas for you. If you are in MA it may be cheaper for you to buy a health plan on the state exchange that covers the surgery. Unfortunately open enrollment just closed so you would need a qualifying event or to wait until November to enroll.

There are some great programs in ma. Lowell general and Emerson hospital both have fantastic and well rated programs. They can also help figure out insurance options.

My surgery took 45 min with one night stay in the hospital. I took 2 weeks off work. I have a desk job and could probably been ok at 1 week, but I’m glad I took two. At 2 weeks I could have soft foods (week 1 was liquid only) and was starting to feel more normal.

i returned to swimming at 3 weeks. My doc gave me the OK to return to running at 6 weeks. However I just didn’t have the energy to run until closer to 10 weeks.

i started losing the first week. My weight loss looks like stair steps. I will have minimal to no loss for 2 to 3 weeks then the next week, I’ll drop ~10. Weight loss over time is not linear, but I am consistently moving down. Compared to several people here, I would be a “slow” loser....but I’m headed in the right direction.

These boards provide a lot of good info when researching. Good luck on your journey.

My surgery was like 8:00,and I was awake by 11. I think it took about an hour. I paid for 2 nights, but was discharged after 1. The hospital did a great job managing nausea, I had none.

I had surgery on Friday, and retained 8 lbs of fluid, but lost all of that by Monday. Then I lost pretty quick for about 3 weeks, but now I've slowed down to 1 or 2 lbs every 2 weeks. But I'm about 6 lbs from goal, and it's to be expected.

I took 4 weeks off, but could have gone back to work within a week. I felt great and enjoyed my 4 weeks of recovery.

9 hours ago, Losebig said:

A couple ideas for you. If you are in MA it may be cheaper for you to buy a health plan on the state exchange that covers the surgery. Unfortunately open enrollment just closed so you would need a qualifying event or to wait until November to enroll.

There are some great programs in ma. Lowell general and Emerson hospital both have fantastic and well rated programs. They can also help figure out insurance options.

Thank you very much. I am in MA and after doing much research have finally decided to pay out of my own pocket. Did you get yours done in MA too? I live in Boston metro area, so it will be very convenient for me to find someone locally to get this done.

7 hours ago, Lannie said:

My surgery took 45 min with one night stay in the hospital. I took 2 weeks off work. I have a desk job and could probably been ok at 1 week, but I’m glad I took two. At 2 weeks I could have soft foods (week 1 was liquid only) and was starting to feel more normal.

i returned to swimming at 3 weeks. My doc gave me the OK to return to running at 6 weeks. However I just didn’t have the energy to run until closer to 10 weeks.

i started losing the first week. My weight loss looks like stair steps. I will have minimal to no loss for 2 to 3 weeks then the next week, I’ll drop ~10. Weight loss over time is not linear, but I am consistently moving down. Compared to several people here, I would be a “slow” loser....but I’m headed in the right direction.

These boards provide a lot of good info when researching. Good luck on your journey.

Thank you for your response to my post and for sharing your experience. I wish you luck with your weight loss.

52 minutes ago, GassyGurl said:

My surgery was like 8:00,and I was awake by 11. I think it took about an hour. I paid for 2 nights, but was discharged after 1. The hospital did a great job managing nausea, I had none.

I had surgery on Friday, and retained 8 lbs of Fluid, but lost all of that by Monday. Then I lost pretty quick for about 3 weeks, but now I've slowed down to 1 or 2 lbs every 2 weeks. But I'm about 6 lbs from goal, and it's to be expected.

I took 4 weeks off, but could have gone back to work within a week. I felt great and enjoyed my 4 weeks of recovery.

Thank you very much @GassyGurl for sharing such details of your experience. Every single detail helps me a lot towards my research. I wish you luck in your journey.