Breaking the bank??

[k_podski 2]

So I have been in contact with my insurance, Harvard Pilgrim. As I suspected, they currently do not cover VSG. However.. The woman that I spoke with said that between her and I (?!) she believed it was in the process of being a covered surgery as long as it's medically neccesary, well documented history, blah, blah, blah.. But she wasn't sure about a revision?? Is it possible for her to know this info?? And if the insurance company covers the surgery why is a revision considered a different procedure?

I have thought a little about financing the surgery myself and heading to Mexico.. I'm not so sure I could afford what the payments might look like? Does anyone know what a finance plan looks like through Dr. A's office? I know they offer through a few different companys, but I'm curious if it's even worth looking into? Generally anything like that through an office offers an extremely high APR and outrageous payments. If I do a personal loan I'm sure it would be a high APR as well..

Maybe I should wait on Harvard Pilgrim and see what happens??? Even if they did end up covering the surgery, I wouldn't know where to start in the US with a surgeon as I'm sure that no one in Maine does VSG... (Although I believe there is someone in Boston?)

So yah, a whole lot of questions here. Hopefully you guys can understand my thought process here, I'm working on negative sleep and lots of coffee today:)

Thanks in advance for your responses!

Kerri:)

[Oregondaisy 2,020]

All you can do is call and ask .

they have their toll free# listed to the right

of the screen.

[Elisabethsew 50]

So I have been in contact with my insurance, Harvard Pilgrim. As I suspected, they currently do not cover VSG. However.. The woman that I spoke with said that between her and I (?!) she believed it was in the process of being a covered surgery as long as it's medically neccesary, well documented history, blah, blah, blah.. But she wasn't sure about a revision?? Is it possible for her to know this info??

Yes, they frequently know the upcoming changes as they need to be trained in order to advise people and process requests.

And if the insurance company covers the surgery why is a revision considered a different procedure?

Revisions carry a higher risk. You have to take out the band, deal with adhesions, etc. It costs more money and some surgeons don't even do the procedure.

I have thought a little about financing the surgery myself and heading to Mexico.. I'm not so sure I could afford what the payments might look like? Does anyone know what a finance plan looks like through Dr. A's office? I know they offer through a few different companys, but I'm curious if it's even worth looking into? Generally anything like that through an office offers an extremely high APR and outrageous payments. If I do a personal loan I'm sure it would be a high APR as well..

I can't speak to the financing. I took money from savings and borrowed the rest from my sister.

Maybe I should wait on Harvard Pilgrim and see what happens??? Even if they did end up covering the surgery, I wouldn't know where to start in the US with a surgeon as I'm sure that no one in Maine does VSG... (Although I believe there is someone in Boston?)

Waiting depends on your health. Are you having problems? Is the band interfering with your life, sleep, work? If no, you can afford to wait for insurance to pay.

So yah, a whole lot of questions here. Hopefully you guys can understand my thought process here, I'm working on negative sleep and lots of coffee today:)

Thanks in advance for your responses!

Kerri:)

My situation made it necessary to get the band out ASAP. I could not spend 6-9 months creating a paper trail of problems and then apply for insurance to approve a revision but your situation might be different. It doesn't cost a thing to call and ask what the APR for financing is.

[Ruthi 60]

Yes, you are correct, these companies have high interest rates and feed on our desperation. Some of us that are self pay have even borrowed against our 401K's to get this done. I figure why not, I wont live to use my 401K if I dont do something about my weight. Good luck to you no matter what you choose.

Ruthi

[MacMadame 81]

The woman that I spoke with said that between her and I (?!) she believed it was in the process of being a covered surgery as long as it's medically neccesary, well documented history, blah, blah, blah..

There is a rumor going around that the ASMBS is going list the sleeve as an approved procedure and not experimental. If that happens, the insurance companies will start approving it in much greater numbers.

But it's just a rumor.

But she wasn't sure about a revision?? Is it possible for her to know this info?? And if the insurance company covers the surgery why is a revision considered a different procedure?

Maybe she meant the approval criteria would be different... I'm guessing that because it often is.

[roseyandmusic 0]

I am financing through eFinancing. I was approved for $8000, so I need to raise 1500. What this co. did was send me a Visa credit card and my payments will be like payments for any credit card. Its not like a loan. I get the first six months no interest. Then starting the seventh month, it'll be 10. something plus the prime (which is about 3 something right now). I only agreed to this because in this economy, I don't think the prime will raise. So I am expecting no more than 15%. Its not great, but its what I need to do. My goal is to pay off as much as I can the first 6 months so that when my interest kicks in, it will be on a lesser amount.I am thinking my minimum payments will be 250 to 300 a month. Its going to make things tight. But the way I see it is I am investing for a long, healthy life.

[k_podski 2]

My situation made it necessary to get the band out ASAP. I could not spend 6-9 months creating a paper trail of problems and then apply for insurance to approve a revision but your situation might be different.

I am having SOME issues that I've been dealing with mostly all along. My GERD is back as I suspected it would be. When my doc was in there he said my hiatal hernia "wasn't that bad" so he did not fix it. I was without reflux for almost a year, then in January it started up again. My reflux now makes me nauseous so I am on meds for both now. The nausea med makes me want to sleep all day.

I have also had a sore port since day one. I had a revision in Nov last year, and it continues to bother. There is a dull ache all the time, although when I sit, stand, or bend, forget it, it feels like it's getting ripped out. When I went to my doc for this he asked "does it hurt when you touch it?" I said yes, to which he replied "then don't touch it and you will be fine..." Thanks. 'Preciate that.

I also am hungry ALLLLLL the time.

I've been working with my nutritionist every two weeks for god knows how long now. I'm sick of being hungry. I've been hungry all my life. That's why I'm fat. No it's not head hunger, no it's not poor food choices, no I'm not an emotional eater.. I'm effing hungry, can't you just hear me out??? I'm sick of cramming in 75 grams of Protein a day to prove to them it's not lack of Protein. "Add another 5g-10g in, you should feel better then." Ugh.

I spoke with the nurse from the bariatric center who also has a band. She suggested I look into the VSG originally because of a possible hunger hormone issue. She is getting a VSG in July. When I brought this up to my Doc he pretty much laughed in my face. I think that he thinks I'm not doing the right things. Granted I don't exercise as much as I should, but I do damn good, and am a different person than I was a year ago. I wish they could follow me around for a week to see what I go through:(

So yah, sorry to let loose, I kind of needed to get that out. lol

I guess I'm confused about pre op and post op stuff if Mexico is chosen for surgery too. Will I need to do post op here in the US with my current doc? Because EEEEK, I don't think that will work out well.. And how does the pre op stuff work? Is it all done once you get there??

Thanks again for your time and responses!

Kerri

[Elisabethsew 50]

I am having SOME issues that I've been dealing with mostly all along. My GERD is back as I suspected it would be. When my doc was in there he said my hiatal hernia "wasn't that bad" so he did not fix it. I was without reflux for almost a year, then in January it started up again. My reflux now makes me nauseous so I am on meds for both now. The nausea med makes me want to sleep all day.

I have also had a sore port since day one. I had a revision in Nov last year, and it continues to bother. There is a dull ache all the time, although when I sit, stand, or bend, forget it, it feels like it's getting ripped out. When I went to my doc for this he asked "does it hurt when you touch it?" I said yes, to which he replied "then don't touch it and you will be fine..." Thanks. 'Preciate that.

I also am hungry ALLLLLL the time.

I've been working with my nutritionist every two weeks for god knows how long now. I'm sick of being hungry. I've been hungry all my life. That's why I'm fat. No it's not head hunger, no it's not poor food choices, no I'm not an emotional eater.. I'm effing hungry, can't you just hear me out??? I'm sick of cramming in 75 grams of Protein a day to prove to them it's not lack of Protein. "Add another 5g-10g in, you should feel better then." Ugh.

I spoke with the nurse from the bariatric center who also has a band. She suggested I look into the VSG originally because of a possible hunger hormone issue. She is getting a VSG in July. When I brought this up to my Doc he pretty much laughed in my face. I think that he thinks I'm not doing the right things. Granted I don't exercise as much as I should, but I do damn good, and am a different person than I was a year ago. I wish they could follow me around for a week to see what I go through:(

So yah, sorry to let loose, I kind of needed to get that out. lol

I guess I'm confused about pre op and post op stuff if Mexico is chosen for surgery too. Will I need to do post op here in the US with my current doc? Because EEEEK, I don't think that will work out well.. And how does the pre op stuff work? Is it all done once you get there??

Thanks again for your time and responses!

Kerri

Your surgeon sounds like a complete ass and the nutritionist sounds like one also. He probably doesn't have the skill to perform a revision to VSG and that's why he's laughing. He'll be crying when the band surgery is history and his money flow is compromised. What goes around comes around.

If your BMI is 40 or more (like mine), you'll be required to do a pre-op diet for a week. You can have only 30 g carbohydrates a day for that week. Lean meats, poultry, chicken, etc. are all allowed so it's not too bad... nothing like a liquid diet.

On the last day of the pre-op diet, you can't have anything for 6 hours prior to your blood work. I arrived in Mexico on Tuesday at @ 1 PM their time and was met by the driver at the airport. He drove me to the hospital where the RN was waiting for me. I gave a urine sample, then had bloods drawn, then had an EKG, then went for a chest x-ray, and ended with the barium swallow. During the swallow, the band is evaluated and completely unfilled. All of this took less than an hour. The final step is meeting with Yolanda who takes the payment and gives you forms to fill out and bring back the next day.

The driver was waiting when I finished with Yolanda and he drove me a short distance to the Lucerna Resort. He paid the room bill (included in the surgery price as were the pre-op tests) and walked me to the room which was spacious and gorgeous (2 full size beds, table and chairs, recliner, full bath). You are allowed to have anything you desire for dinner and the resort has 3 restaurants (and 3 pools). I brought a sandwich with me as I worked the night before traveling and had been awake over 38 hours. My last meal was a Peanut Butter and jelly sandwich. LOL.

At 7 AM the next day you are picked up at the resort and brought to the hospital. You go directly to your hospital room and see the medical MD, the anesthesiologist, the assistant surgeon (Campos), and the surgeon, Dr. A. All rooms are private with a leather love seat or couch, a chair, hospital bed, and private bath. They have internet access free. You change into a hosp. gown (they have bariatric gowns) and get 2 pills that knock you out. LOL.

After surgery, you go to the recovery room and then go back to your room. Dr. A. has his own unit so it's just his patients which minimizes infection. You are constantly checked on by RNs and I saw Dr. A. three times a day. I've been a registered nurse for MANY years and can only saw positive things about my time in Mexico.

I hope that helps you out. The transportation from and back to the airport is also included in the surgery price.

[k_podski 2]

Yes Elisabeth, that was really helpful! I guess I hadn't given my BMI much thought.. It is now 35. I am 197lbs and 5'3". Could this compromise the possibility of a revision?? I would like to lose another 60lbs or so. As for my surgeon and nutritionist, yah.. You got the idea lol I should have known better at the beginning when my surgeon asked me which surgery he did on me and whenhe had done it, when I was there for my final consult pre op. Then for my second fill he asked me if I had a fill yet and how much I had in my band. Yikes! What was I thinking:(

Thanks again for your reply, I really appreciate it!!

~Kerri

Edited May 8, 2009 by k_podski

[Elisabethsew 50]

Yes Elisabeth, that was really helpful! I guess I hadn't given my BMI much thought.. It is now 35. I am 197lbs and 5'3". Could this compromise the possibility of a revision?? I would like to lose another 60lbs or so. As for my surgeon and nutritionist, yah.. You got the idea lol I should have known better at the beginning when my surgeon asked me which surgery he did on me and whenhe had done it, when I was there for my final consult pre op. Then for my second fill he asked me if I had a fill yet and how much I had in my band. Yikes! What was I thinking:(

Thanks again for your reply, I really appreciate it!!

~Kerri

If you're having surgery as a self-pay, you don't have to worry about the BMI. WASA had a revision when she was at (even a little below) her goal weight. The lower your weight, the easier it usually is for the surgeon so you're good to go.

[WASaBubbleButt 41]

So I have been in contact with my insurance, Harvard Pilgrim. As I suspected, they currently do not cover VSG. However.. The woman that I spoke with said that between her and I (?!) she believed it was in the process of being a covered surgery as long as it's medically neccesary, well documented history, blah, blah, blah.. But she wasn't sure about a revision?? Is it possible for her to know this info?? And if the insurance company covers the surgery why is a revision considered a different procedure?

I have thought a little about financing the surgery myself and heading to Mexico.. I'm not so sure I could afford what the payments might look like? Does anyone know what a finance plan looks like through Dr. A's office? I know they offer through a few different companys, but I'm curious if it's even worth looking into? Generally anything like that through an office offers an extremely high APR and outrageous payments. If I do a personal loan I'm sure it would be a high APR as well..

Maybe I should wait on Harvard Pilgrim and see what happens??? Even if they did end up covering the surgery, I wouldn't know where to start in the US with a surgeon as I'm sure that no one in Maine does VSG... (Although I believe there is someone in Boston?)

So yah, a whole lot of questions here. Hopefully you guys can understand my thought process here, I'm working on negative sleep and lots of coffee today:)

Thanks in advance for your responses!

Kerri:)

A revision is a very different procedure, it requires more OR time for one. Also, you HAVE to go to a true revision surgeon and not just someone who does bands and sleeves. The risks for bleeding, perforation, infection, and leaks is 3x greater in a revision vs. a straight sleeve procedure.

Does your insurance cover DS? There might be a way around this insurance issue in getting a sleeve. ;o)

[k_podski 2]

Does your insurance cover DS? There might be a way around this insurance issue in getting a sleeve. ;o)

This what is covered as of 10/2008:

• Bariatric surgeries, including gastric stapling, vertical banded gastroplasty, gastric lap banding for obesity, biliopancreatic

diversion with duodenal switch, and gastric bypass surgeries with required prior authorization from Harvard Pilgrim.

[Elisabethsew 50]

This what is covered as of 10/2008:

• Bariatric surgeries, including gastric stapling, vertical banded gastroplasty, gastric lap banding for obesity, biliopancreatic

diversion with duodenal switch, and gastric bypass surgeries with required prior authorization from Harvard Pilgrim.

Vertical banded gastroplasty is the sleeve.

[MacMadame 81]

Vertical banded gastroplasty is the sleeve.

Actually, it's not. It's some old procedure that insurance still pays for even though it sucks. They put a mesh band around the top of your stomach and they separate out part of your stomach from the rest, but they don't cut the rest off.

[Elisabethsew 50]

Actually, it's not. It's some old procedure that insurance still pays for even though it sucks. They put a mesh band around the top of your stomach and they separate out part of your stomach from the rest, but they don't cut the rest off.

thanks for the correction... I was thinking gastrectomy.