Frustration

[tbduarte1 2]

I am not one that does well with being patient and therefore I am in a terrible place mentally. I never thought about having surgery as I didn't know the options that are available today. Meeting with my Dr, we talked about Wegovy and the lifetime issues I has had with weight loss and the continued failure to do so. He suggested sleeve surgery. At first I was not going to consider it thinking it wasnt for me. After weeks of research I decided it was the exact thing I needed in my life. This is where the impatience comes in. I met with a surgeon for consultation and I started getting excited about all prospects of life changing results this would bring.

- Lowering bp and getting off all meds

- recovering some kidney function

- getting rid of sleep apnea or at least losing enough BMI that I could get an implant because I cant keep my mask on

- Being able to become an athlete again

- Not needing an extension on the airplane

- Other benefits that are personal.

I waited a week for them to run my insurance and it was denied. Now I am stuck saving enough money to try and get it in the distant future. I am not mentally doing well with that fact. I got it in my head that I was going to get on the right path for me sooner rather than later. I looked into financing but I am a teacher and can not afford an extra "car payment". So I need to save and wait...impatiently.

[Brandee.Davis 3]

DON’T GIVE UP!!!

[NickelChip 685]

Do you know why you were denied? Sometimes your doctor can make an appeal on your behalf and the decision will be reversed, although the circumstances are very much case by case. Generally, if you have 40+ BMI, or 35+ and you mentioned having sleep apnea and high blood pressure, you would be considered a good candidate.

In the meantime, I'd like to recommend you check out Dr. Weiner's Pound of Cure videos and podcast, plus there's a book by the same name. I found these resources back in the summer and I started implementing the suggestions slowly and have seen some promising results. Not WLS level results, but I'm down about 15 pounds and my labs were so much better in just 6 months for things like cholesterol and to a lesser extent blood sugar. I really can't say enough good things about Dr. Weiner, honestly. And they're all the type of lifestyle changes you'll need to consider anyway for your best shot at longterm success. Think of it as training for when (not if!) you have the surgery.

But keep at it with the insurance. Some of them have a lot of hoops to jump through and it feels impossible but if you don't give up, you might make it happen.

[tbduarte1 2]

I contacted the insurance company and the packages offered to my school have zero bariatric coverage. Thanks for the resource suggestions.

[NickelChip 685]

Oh dear. That makes it harder. If you were at a private company, I would suggest going to HR and asking them to look into adding bariatric coverage. But with schools, you're probably looking at union contracts and policies that extend to the whole state. It doesn't mean it's not worth asking if you have an HR person or teacher's union rep who would be in charge of this type of thing, but it might be a lot harder. There is always the Mexico route for self pay. My brother did it about 15 years ago when you couldn't get a sleeve in the US pretty much anywhere, and he had an excellent result. I know there's a whole forum on here for Mexico.

[BigZ 65]

I did the Mexico self-pay, even with my insurance the process was almost a year long before approval, and estimated costs out of pocket were still more than going to Mexico. I wouldn't touch semaglutide with all the issues with it and weight loss. It works for some, but the friends I know who have done it have all put back on all their weight and 20 pounds after they quit it. Too many issues that can happen with it, stomach paralysis, rotten food in your stomach, etc. If you have HSA/FSA there are ways they will cover your surgery in Mexico or go towards the cost. I had a lady in my surgery group in Mexico that was able to use her HSA/FSA completely, I know she said she had other paperwork etc she had to do and get approval before hand as it was out of the country. I believe Go Light Bariatrics has a financing option, and I want to say it was interest free.

[NickelChip 685]

1 hour ago, BigZ said:

I believe Go Light Bariatrics has a financing option, and I want to say it was interest free.

Wow, I just checked their website and under $5k for VSG and under $6k for RNY is super affordable. My copay plus deductible with insurance here in the States will still end up running me $3,000 (no matter which surgery you choose), but I'm sure the bill they will send to insurance will be eye-watering. I had no idea the prices in Mexico were so low these days. Back 15 years ago, it cost quite a bit more in Mexico from what my brother told me, but you couldn't even get it done here for the most part as no insurance was covering it back then and they were calling VSG experimental.

[BigZ 65]

My surgeon run's specials, I think my overall cost was 4200. My daughter had it done same day with me and she was 3700.