New here but my journy is already 3 years long with no end in sight....

[ksosne]

Been trying to get insurance coverage for the sleeve for several years now. Also been trying to save/raise money to self pay and get it done in Mexico. So far no luck whatsoever. My previous insurance covered the gastric bypass and lapband but I don't want those procedures. Went through appeals and dr letters and everything and always denied. Now since my husband just started working at Boeing and we got new insurance, I checked again. To my surprise and delight, the sleeve was a covered procedure with no 6 month diet requirement! So I called up the surgery center to get things going only to find out that our particular group number has a specific exclusion to ALL bariatric surgery. GRRRRR!!! I am frustrated beyond words!

I'm 38 but I feel 90. I have a herniated disc and rheumatoid arthritis in my back which leaves me hardly able to walk. Fibromyalgia, diabetes, sleep apnea, liver damage, etc etc etc. Only thing I don't have (yet) is high blood pressure. I'm in pain all the time and miserable in my own skin. I need this surgery to literally save my life! My kids are watching me die a little more each day. I just want to scream!

I'm on disability because of all of this so my next step is to see if Medicare part B may cover this procedure yet. I never used it because I had insurance through my husbands work and it didn't before but I'm thinking I may add it if there is any possibility of getting them to cover it now. But I have no idea if I need a certain supplement plan or how to find that out to get coverage! I spent most of the day in tears after finding out about the exclusion. Every time I think I may be getting close, another door gets slammed shut in my face.

Sorry this got so long, I just needed to vent to people that understand what I'm going through. No one else around me understands because I'm the only one who's severely overweight. I think at this point I'm ready to sell my soul!!

[Kelly Jo]

Very sorry for your difficulties. I don't think Medicare covers sleeve but its worth looking into. Can you get a loan for self pay? Many surgeons in the States are under $10,000. Good luck to you.

[gemini_1984]

I know this is a sleeve forum and all, but I support the bypass procedure for those who choose that route. I'm wondering with all you've been through and the fact that your comments would lead most of us to believe that you're at your wits end - why do you not want the bypass? I understand the rerouting of intestines can turn some people off and the malabsorption is more severe than the sleeve, oh and the dumping syndrome, but I guess this is where I would start weighing the pros and cons.

[Symplee37]

I'm sorry for your difficulties, but I would look into the Medicare, anything is worth a try at this point. Good luck to you!

[Trish165]

I am sooo sorry, good luck.

[jerzeygirl]

I agree w/Gemini. If that's the only type of WLS that your insurance covers, you might do well looking into it a little farther. I know people who have been very successful w/gastric bypass, and self-pay is very hard on someone who is having any type of financial difficulties (and who isn't today). Please don't shut off the option of gastric bypass as all weight loss surgeries have pros/cons. I wish you continued success in your search for a better, healthy life.

[itsmytime]

I am so sorry you are going through this! I know it can be frustrating. I hope you can get the sleeve. Please don't give up. I have to agree with the other posters if your health is as bad as you say it is, the gastric bypass could be a life-saving procedure for you if you can't give the sleeve. Please do what you feel is best, it is your body of course. I really hope you get what you desire!

[franca1221]

I had my surgery with Dr Rodriguez in Mexico and I think that they might have a payment plan ( not sure) Go to the belight website and call them. I'm sure they will help you. It's worth trying. Good luck

[Lily]

U can also try contacting one (or all) of our Mexican doctors. U just never know, maybe one of them will give u a break on the price. I know many of them do it at 1/3 of price for the locals due to low income.... My doctor is Dr.Alvarez and he has such a wonderful carrying personality. His prices are a little high but I ve heard about a lot of other doctors who are just as good but a little less expensive.

As far as money goes, I was debating about this for a while too. I am a student and have over 70,000$ bill that I have to start paying in a few months... So adding another 10,000 seemed crazy but ... I felt like I was making an investment into my life. I felt like i always put others ahead of myself, but this time it's just for ME. I explained this to my husband and he understood...
Well, good luck!
Love
Lily

[EllaK]

I am sorry that I can't give you any helpful suggestions but I just wanted to say that I really feel for your situation and I hope that you will be able to get funding really soon.

[Evie Sleevie]

Where there is a will, there will be a way. You can make the sleeve happen for you. Go to your bank and ask about medical/personal loans. Research Mexico--I went there and have NO REGRETS at ALL! We have all been where you are right now. Good luck to you. Research your little head off, and see what you can find out! xoxox

[Grace]

Unsure of if it is something that can work for you but you might see if you can do COBRA on your last insurance? It may not be possible because you have ins available to you now, just a thought. I once used COBRA to get a hysterectomy after I got laid off.
Otherwise, Medicare part b appears to be just docs, not hospitals.
You can start by calling medicare or going to this webpage and seeing where it takes you...
Medicare.gov - Your Medicare Coverage
Here's the latest update on the coverage manual
http://www.cms.gov/Regulations-and-G...03c1_part2.pdf
Unfortunately, if you look at pg 9-10 it indicates they are covering rny and banding but still not VSG.
Honestly, if I were you, I'd go ahead and get the rny, especially since you have diabetes.
It may be several more years before VSG is covered, I don't think I'd wait...
wishing you well

[Sunflower]

I think the Mexico option fr you would be the best bet. Does your husband's new job offer a Flexible Spending Account? I used mine to pay for my Mexico sleeve with Dr. Kelly. Dr. Kelly wrote me an invoice/receipt and I submitted to my FSA and they cut me a check. I pay for it a bit each month out o fmy check, but this was very doable for me this way. Good luck.

[Regie]

Be careful though. Find out from Medicare if once you have the procedure, will they pay for follow-up? I know a lot of people who have fallen in this trap with regular insurance, it's one of those fine line things. You can also talk to someone who has actually paid for their own instead of filing Medicare.
I hope this helps. Welcome to the forum.

[gemini_1984]

Be careful though. Find out from Medicare if once you have the procedure, will they pay for follow-up? I know a lot of people who have fallen in this trap with regular insurance, it's one of those fine line things. You can also talk to someone who has actually paid for their own instead of filing Medicare.
I hope this helps. Welcome to the forum.

My surgeon told me that there is a 90 day window (I forget what the term was they used) after this procedure where the surgeons office agrees not to bill the insurance company for follow up care for those 90 days. I don't know if this varies by each insurance company but you'd think they'd all smarten up and follow lead. Anyways just thought I'd share!