Considering getting a gastric sleeve

[Dest 0]

Hi I’m dest I am 22 years old my height is 5’4 and weight 220 I’m in California and I have insurance it’s anthem blue cross ppo I don’t know if they would cover a gastric sleeve or if I would even qualify, am I suppose to call the number on my card to get these answers? Unfortunately I have not seen a doctor yet I’m new to all of this, I’ve been thinking I can always go to TJ for the surgery but if my insurance can cover it here then why not? I’ve also been looking for someone built like me weight and height Wise if you have done the sleeve how are your results? Or if you have gone through your own insurance how much did you have to end up paying for your co pay? Ah so many questions! Thank you in advance for any advice!

[JessLess 1,163]

Insurance coverage will be based on your BMI and if you have comorbidities like high blood pressure, sleep apnea, or diabetes. Yours is 37.8. Mine was covered with no comorbidities at 40. If you have one, you may be able to get coverage at 35.

I started at 5'6" and 250 lbs. I'm 50, so a lot older than you are. I lost 80 lbs. and have gained 12 back in about 2 years. I had no complications and was happy with the experience overall.

The thing I didn't fully understand is that my appetite would come back and I would be on a serious, calorie counting diet forever to maintain my loss.

[Mr Alley Gator 263]

6 3 so taller and 52 Dropped 177 pounds last year from June to december 27

Read this whole site and make sure you go to the male section - Best decision i made but it is a tool and you have to set up and run the workshop!

[mattk53 124]

I also have Anthem Blue Shield PPO and live in California. I had all the comorbidities Jess mentioned and it still took forever to jump through all the hoops they put in front of me. 15 Months it took before my first meeting and my surgery. It was definitely worth it, but it is a process. Not just a quick fix.

[Dest 0]

12 hours ago, JessLess said:

Insurance coverage will be based on your BMI and if you have comorbidities like high blood pressure, sleep apnea, or diabetes. Yours is 37.8. Mine was covered with no comorbidities at 40. If you have one, you may be able to get coverage at 35.

I started at 5'6" and 250 lbs. I'm 50, so a lot older than you are. I lost 80 lbs. and have gained 12 back in about 2 years. I had no complications and was happy with the experience overall.

The thing I didn't fully understand is that my appetite would come back and I would be on a serious, calorie counting diet forever to maintain my loss.

Ah i see well from what i know i haven't been diagnosed with any of the above, but that's just because i have been going to my obgyn. I am currently looking for a primary care physician so do you think this will cut my chances

[sizemedown 42]

Insurance coverage will be based on your BMI and if you have comorbidities like high blood pressure, sleep apnea, or diabetes. Yours is 37.8. Mine was covered with no comorbidities at 40. If you have one, you may be able to get coverage at 35.
I started at 5'6" and 250 lbs. I'm 50, so a lot older than you are. I lost 80 lbs. and have gained 12 back in about 2 years. I had no complications and was happy with the experience overall.
The thing I didn't fully understand is that my appetite would come back and I would be on a serious, calorie counting diet forever to maintain my loss.

Oh no! Your appetite comes back??? Wth? That's news to me and I'm less than a week away from surgery. Oh Lord. How do you deal with that?

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[Dest 0]

8 hours ago, mattk53 said:

I also have Anthem Blue Shield PPO and live in California. I had all the comorbidities Jess mentioned and it still took forever to jump through all the hoops they put in front of me. 15 Months it took before my first meeting and my surgery. It was definitely worth it, but it is a process. Not just a quick fix.

oh wow that is a long time yeah i dont have any diagnosis of any of the above, i just know i am pretty overweight and have tried plenty of diets and routines but ive always just been bigger than most. im glad your process was worth it!

[Dest 0]

10 hours ago, Mr Alley Gator said:

6 3 so taller and 52 Dropped 177 pounds last year from June to december 27

Read this whole site and make sure you go to the male section - Best decision i made but it is a tool and you have to set up and run the workshop!

wow congratulations! yes im new to the site i really dont know how it works yet

[JessLess 1,163]

33 minutes ago, askmehow said:

Oh no! Your appetite comes back??? Wth? That's news to me and I'm less than a week away from surgery. Oh Lord. How do you deal with that?

It's much better than it was, and my capacity to eat is less. I count calories and come on here almost every day to remind myself what motivated me to get the surgery and lose the weight. There was a support group at my hospital, but with COVID, it's online and not as motivating.

[JessLess 1,163]

1 hour ago, Dest said:

Ah i see well from what i know i haven't been diagnosed with any of the above, but that's just because i have been going to my obgyn. I am currently looking for a primary care physician so do you think this will cut my chances

It may cut your chances of insurance paying for it. But not of you getting it. They may decide to test you for sleep apnea anyway. I had Harvard Pilgrim and for me (and people who self pay) the process was super fast. I got my surgery about 2 months after I decided I wanted it.

[Dest 0]

9 minutes ago, JessLess said:

It may cut your chances of insurance paying for it. But not of you getting it. They may decide to test you for sleep apnea anyway. I had Harvard Pilgrim and for me (and people who self pay) the process was super fast. I got my surgery about 2 months after I decided I wanted it.

oh okay well maybe when i do go see my doctor something might pop up.. who knows i know forsure i cant afford it out of pocket i will probably have to go to TJ if i wanted to pay full price much less then california /:

[sizemedown 42]

42 minutes ago, JessLess said:

It's much better than it was, and my capacity to eat is less. I count calories and come on here almost every day to remind myself what motivated me to get the surgery and lose the weight. There was a support group at my hospital, but with COVID, it's online and not as motivating.

Good. I'm glad its better. Yes, I'm loving that we all have eachother.

[Zoomzoom 45]

My insurance here in CA only covered half after the deductible. With all of the hoops and costs, I figured out that it would cost me more out of pocket than if I did self pay. So I went with a self pay option at Blossom Bariatrics in Las Vegas.

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