POSTED UNDER Gastric Sleeve Surgery Reviews
Insurance Question. Please Help! - Austin, TX
UPDATED FROM lale2010
Getting sleeved on Monday!
lale2010December 18, 2015
$12,000
WOW!!! 2 months later here I am...on my preop diet, waiting to be sleeved on Monday. My nerves are starting to get the best of me, so I have to ask. Have any of you that have had the procedure regretted it? That's one of my fears right now. Any encouraging words are very much appreciated. Thanks!
UPDATED FROM lale2010
Hoping to get sleeved by the end of the year!
lale2010October 16, 2015
I went to my consultation today with my supportive husband. Everything went great! I'm 5'2 (I thought I was 5'3), weight 226 and BMI is 41.3. The Dr. asked me what procedure I was wanting, I told him the sleeve, he asked me why, and I answered. He agreed that the sleeve was MY best option. He talked to my husband and I, pretty much walked us through the process and what our next steps will be. My awesome insurance requires and 3 month weight management program. I could either go through my PCP or do it at my surgeon's practice. The weight management program costs $300 (not covered by my insurance) I also have to meet with a dietician months 2 and 3 and that's an additional $120 per visit. The thing about my AMAZING insurance is that my family out of pocket is $400 and I've already met a little over $300. By the time I'm done with my pre-op testing, lab work, dr visits, my $400 OOP will be met and my surgery will cost me $0! Yay!!! That's only if we can get it done by December. The dr's staff came into the room to talk to me about it. Basically, we're scheduling my first visit on 10/28/15, my second visit 2 weeks later in November, and the last one in early December. That will give them time to send everything to my insurance company and I should *fingers crossed* be approved within 2 weeks. I am so freaking excited! Scared, but excited more than anything! I can't wait to look better and feel better about myself. I can't wait to not be tired all the time and be more active with my children!
Replies (2)
October 17, 2015
Hi there, welcome to the WLS community!
So glad your consultation went well and your husband is beign so supportive! Family support is really important. :-)
We have a very active Sleeve Forum, if you're looking for support. There are hundreds of other sleevers in there and we're all on the same journey.
You should also check out the links below to some
guides, which may help you prepare.
Sleeve
Gastrectomy Guide
Food
Survival Guide
Nutritional
Guide
Good luck and please keep us updated with your progress.
October 21, 2015
I am also in a super fast push for approval. Nerve racking! I only pay 200.00 if the surgery is in December. More if in 2016.
You and I should be having surgery around the same time!!
You and I should be having surgery around the same time!!
ORIGINAL POST
So hopefully my journey starts on Thursday. That's...
lale2010October 13, 2015
So hopefully my journey starts on Thursday. That's the day of my initial consultation. I am 5'3 and 230ish. Not sure how accurate my scale at home is, but I'm pretty sure my BMI is 40. My insurance requires and 3 month weight management program and a psych eval. Does insurance require me to lose weight in those 3 months in order for them to approve the surgery? If I'm 230 right now, and I lose a few pounds, I'll be under the 40 BMI requirement. I'm so bummed! Ugh...I've done anything and everything to lose weight. Every shake, pill, wrap...I have even done it the "right" way by eating healthier and exercissing. My problem is that I always gain it all back. I think the sleeve is my best option, but now I'm kinda discouraged thinking that my insurance won't cover it. No negative comments please. I'm just trying to find some answers.
Replies (2)
October 21, 2015
Every insurance is really different. Mine madee do 6 months of classes and they have actually been really helpful. I was totally pissed at first that I had to wait but now am very glad as I have learned so much to be more successful with the sleeve.
My insurance requires a weigh in at each class and there's one class a month. I cannot gain any weight. I have lost almost 20 lbs. just sort of practicing the techniques for success. If I weigh one pound more than my start weight then I have to start over for another six months of the same classes! That motivated me to not gain!!
Best of luck and please update us!
My insurance requires a weigh in at each class and there's one class a month. I cannot gain any weight. I have lost almost 20 lbs. just sort of practicing the techniques for success. If I weigh one pound more than my start weight then I have to start over for another six months of the same classes! That motivated me to not gain!!
Best of luck and please update us!
October 21, 2015
My insurance requests the 3 month program and that I also lose 5% of my body weight. That's 11 pounds, if I lose 11 lbs then my BMI lowers to 39.6. I'm afraid that by doing that, they will think that I no longer qualify for the sleeve. My Dr. told me to try to lose 4-5 pounds only. I work for a hospital network that has several hospitals in the Austin area and my surgeon and his staff seem to be familiar with the insurance. They say that they are not THAT strict and that I should be good. If all goes well, my surgery should on December 21st! I'm beyond nervous, excited, scared, happy all at the same time. Keep me posted as well! It's nice to have the support of others in the same situation as me. My family is supportive, they just don't understand what I'm going through.
January 4, 2016
I'm in a similar situation. I just make the cut off and had to wait until after I had my second child so I could utilize the pregancy weight gain to give me a little wiggle room to lose weight during the 3 month pre op period. I've been overweight most of my adult life, so I wanted to correct the behavior before it got worse or I passed my poor habits on to my children.
In terms of being on the edge of the BMI requirements, I've read that some people pad their initial consultation weight by securing a few of the 2 lb mini sand bags to themselves from the 10 lb ankle weights. As long as you wear something a bit baggy, like a hoodie, I would think this would work. To not have insurance cover your surgery because you are obese, but a pound or two away from being morbidly obese would be a shame.
Anyway, since I read that you had the surgery, I guess you didn't have an issue. Congratulations and I can't wait to read your update!
In terms of being on the edge of the BMI requirements, I've read that some people pad their initial consultation weight by securing a few of the 2 lb mini sand bags to themselves from the 10 lb ankle weights. As long as you wear something a bit baggy, like a hoodie, I would think this would work. To not have insurance cover your surgery because you are obese, but a pound or two away from being morbidly obese would be a shame.
Anyway, since I read that you had the surgery, I guess you didn't have an issue. Congratulations and I can't wait to read your update!
Replies (1)