Won't make it through all the insurance hoops...want to go to Mexico

[tonilee2]

Hi everyone! I recently found this website and you all are the best...very helpful and supportive. I've thought about completing bariatric surgery many times in my life and currently, I'm at my wit's end. I've decided I want to have a VSG performed and I do NOT want to go through our insurance. I want Dr. Alvarez in Piedras Negras to complete the surgery. Problem is I do not have the out-of-pocket funds and my husband is totally against us paying out-of-pocket. He wants me to have the surgery but he doesn't want to pay the out-of-pocket costs for Dr. Alvarez...he wants me to wait for our insurance company to approve the surgery.

What my husband isn't hearing is 1) I will not make the wait if I attempt to get insurance approval, and 2) our insurance is going to deny the surgery. I probably won't get approved even on appeal.

Complicating things is that currently, my BMI is approximately 41.2 and the only comorbidity I have is high cholesterol and moderate osteoarthritis. My doctor does NOT think my weight is contributing to my joint/muscle pain, nor does he think my arthritis is that bad that I need weight loss surgery (or weight loss) to improve the condition. I am a Nurse Practitoner and I worked for a managed care company for approximately four years while living in New York City (lived there for 14 years). I KNOW how insurance companies operate. I KNOW how and WHY the reject requests and claims. I cannot go through it.

Any thoughts, input and advice would be appreciated. Feeling very sad today. Thank you all in advance!

Currently, I am 55 years old, my height is 5'2", my weight is 225 lbs and my BMI is about 41.2

[flipflopgirl]

You WILL NOT go wrong with Dr. Alvarez!!!!! I was just sleeved by him on 2/1/13 and my sister by him on 1/4/13. We haven't had a single problem at all!!!! He is sweet, kind and caring and ALL his staff is great as well!!!! He doesn't use the drains that some people speak of on this site and the leak test is preformed right after surgery while you are still out cold!!!! He also has some kind of machine/tool that sucks out the excess air so there is less gas and the pains that come with it!!!! I was sleeved on Friday and back to work (desk job) on Wednesday!!!! I am happy to sing his praises!!!! Let me know IF I can help or answer any questions for you!!!! He is a God send and a life saver!!!!! God has really blessed him with talent!!!!!

[tonilee2]

You are so so so sweet and kind. Thank you for the reply. I am excited for you that your experience with Dr. Alvarez was so positive. Please tell me...one concern I have is the need for after-care and follow-up once I'm back in the States. Has that been an issue for you, that is setting things up???

[lindmar]

I would check again with your insurance especially about the BMI. If I remember right, a BMI over 40 is enough of a problem on its own to authorize WLS. Over 35 and you might need a co-morbitity. For goodness sake, common sense says that high cholesterol & arthritis will be helped by weight loss! You also might get a 2nd doctor's opinion. It doesn't sound like your doc a very big fan of WLS and you definitely need someone in your corner to help with insurance. My advice is to really pursue insurance (try to keep your hubby happy!)...maybe talk to insurance several times or go to the HR department for help.

[pack89]

Personally, I would call your insurance and ask them directly what their requirements are. Mine were 3 months with nutritionalist, 3 months or weighing in, a psych consult, and some other basic testing. If you've waited this long, another 3 months is nothing to save several $1000's. Even though you are a Nurse Practioner, I can guarantee that using those few months to do some more research on here and read about the different experiences will be extremely valuable to you. Honestly, the time does go by fast.

[hope4me]

Man eighter you're to large or you are not large enough. I wasn't large enough. I knew the insurance would boot me out just for asking and my Dr. wasn't of any help. So today I'm sitting here 2 months out. Cross that boader and happy that I did.

[tonilee2]

Thanks to everyone for the encouragement. Yes, my husband and I discussed the insurance & surgery issues and he believes (as do I) that the mental anguish, delays, consternation and difficulty we will encounter with MiBCN are not worth a few thoursand dollars...they really aren't.

We also agree that the issue of "hard" comorbidities (HTN, sleep apnea, cardiac problems, diabetes, etc) is ridiculous and we're not gonna wait any longer for me to (sadly) develop one or another, along with high cholesterol, arthritis, etc, etc.

Just paid my down-payment to see Dr. Ortiz in April and have him do the surgery. Frankly, I'm relieved!

[Nickijo]

I used my FSA account to pay for mine because my insurance has you jump through a years worth of hoops then only wanted to pay 50% which was still more than we paid. Best wishes to you.