Surgery denied. Is this the end?

[Alycat]

Hi everyone. Still a newbie here and I went to a seminar last night and it really got me excited. I have a BMI of 37 with severe sleep apnea and according to my insurance, I met the criteria for surgery but when the office assistant called me today to follow up, she told me my insurance company (United Health) denied me because they don't consider my issue as "life threatening". My question is, am I at the end of the road? I've been crying all day and I feel like my fight against obesity and sleep apnea are over. Has anyone been in this situation and fought their insurance? I have letters of support from a couple of my doctors including my GYN and psychiatrist stating that bariatric surgery would help me and I haven't even submitted them to my insurance company. Can I appeal or try to back my case up and try again? I need some hope. I really thought I had this and it was giving m something to look forward to. Now I'm so discouraged and depressed I don't know what to do. Someone PLEASE tell me there's still hope.

[Romandona]

You can get your primary care doctor to advocate for you. What about your cholesterol and blood pressure? This things can be taken care of if they are not in the normal range. Talk to your primary care doctor and ask him to advocate for you.
Good luck - don't give up. Join WW in the meantime to help you get on track.

[RehabNurse]

You can appeal the insurance company's decision...but if it were me, I'd simply catch a flight to San Diego and pay $2,999 cash to get sleeved in Tijuana, Mexico like half of the people who post on this forum. There's no red tape involved; you simply pay and get sleeved.

http://longtermvsg.com/gastric-sleev...ijuana-mexico/

[Ranger1]

I agree with RehabNurse. Fighting red tape and unnecessary delays drives me crazy. I went to Mexico even though I had insurance.

Don't give up on yourself or your dream.

[Alycat]

Thank you for responding. My blood pressure and cholesterol are normal. I'm trying to get a letter of support from my primary doctor and two other doctors. I already have my GYN and psychiatrist backing me. So you think it could still possibly happen? I just can't believe considering how severe my sleep apnea is, they denied me. I just don't get it. I had my hopes up too high I guess and now I feel defeated and completely discouraged. I don't know if I should just give up and end up using an APAP machine forever because I'm just meant to be obese.

[azladyrider]

2999? Wow that's as cheap as I've seen it ever but do your research on the docs there. I had mine 4 years ago with Almanza but wouldn't recommend him now after recent reports. Dr Jalil Illan seems good but 5,000 or so.

[RehabNurse]

I don't know if I should just give up and end up using an APAP machine forever because I'm just meant to be obese.

Rather than give up, be fat, and die young, I'd have the surgery in Tijuana. You'll waste months of time appealing the insurance company's decision, and there's a chance they might not budge.

Good luck with whatever you decide.

[Healthmyself]

I had almost exactly the same, severe sleep apnea and BMI of 38. And insurance if I wanted to jump thru the hoops.
I decided a year of my life was important enough to not fight the U.S. system and got sleeved in Mexico a month ago.
Used Dr Almanza who was exceptional. $4500 for him or $3500 for a less experienced surgeon. The cost was inclusive except for airfare, they don't add anything. I don't have car payments this year so I'm making surgery payments ....an investment in me.
The surgery is not without risk.
NOT having the surgery has plenty of risk too. Sleeved patients are 9 times LESS likely to die in the next five years and have an INCREASE of average life expectancy of 6.5 years. 6.5 years for $4500 is a heck of a bargain in you ask me!

From my research a U.S. surgeon loses about 1 in 400 patients, we are after all obese people with many health issues. Almanzas record is more like 1 in 2000 or more. He is also willing to take on more critical patients due to his experience. Much is in your own hands though...follow the directions EXACTLY and do the work. It's not easy and you have to decide you are willing to do whatever it takes...pre op diet, post op care, walk, track your food, get your fluids, take your vitamins, get help for eating disorders, change your eating habits, let go of smoking, alcohol, empty calories and processed foods.

As a nurse myself I was scrutinizing the care all the way and comparing to US standards. They don't have all the latest in hospital equipment. It's more simple and much louder than US hospitals. They have probably 4 times the cleaning staff, everything was immaculate. The nurses are excellent.

My thought is whether you have it in the U.S. Or Mexico you should keep up the fight. This is your life on the line here.

[mrtumnus]

Dr Almanza is excellent...and I was treated like a princess in Mexico..my husband as well ..and he was not even a patient. You can use GOFUND ME, get a loan from Prosper or other loan providers. Sometimes you simply have to think outside the box to make your dream come true.

[mrtumnus]

Melody, perfectly stated..I did great with ALmanza and with the number of patients and type of patients he deals with losses will occur.

[Mbenson5]

Hi everyone. Still a newbie here and I went to a seminar last night and it really got me excited. I have a BMI of 37 with severe sleep apnea and according to my insurance, I met the criteria for surgery but when the office assistant called me today to follow up, she told me my insurance company (United Health) denied me because they don't consider my issue as "life threatening". My question is, am I at the end of the road? I've been crying all day and I feel like my fight against obesity and sleep apnea are over. Has anyone been in this situation and fought their insurance? I have letters of support from a couple of my doctors including my GYN and psychiatrist stating that bariatric surgery would help me and I haven't even submitted them to my insurance company. Can I appeal or try to back my case up and try again? I need some hope. I really thought I had this and it was giving m something to look forward to. Now I'm so discouraged and depressed I don't know what to do. Someone PLEASE tell me there's still hope.

I would keep fighting, but that is because it is the insurance's job it seems to make us, who pay for their services, a moving target... best wishes to you!

[zoey101]

This is completely up to you and nobody can tell you what to do but if I were in your shoes I'd be on the next plane to Mexico. Some people view all of the hoops that the U.S. puts you through as being safer and they care more etc. etc., well I call B.S.. It's all about the almighty dollar and don't let anyone tell you different. The medical world is plain and simple highway robbery and I'll tell you why. I have a cousin and a step brother in-law that are in pharmasutical's sp? and you will die when I tell you what they make. The cousin makes $850,000.00 a year and the step BIL makes $975,000.00 plus bonuses for both of them. I find it disgusting that these people make so much although educated to no end but when I go to pick up a script that isn't covered by insurance and they charge me $686.00 for 8 injections of migraine medication that probably costs about $20.00 to make it's just not right but that's why these 2 make what they make. "Can you tell I'm bitter" lol

The Insurance companies make Millions if not Billions of dollars a year with pre-op this pre-op that, support groups and this test that test and so on. Don't get me wrong some things are good for some patients especially ones that are not committed and don't do their research and follow the rules. But If you are like most of us that did months if not years of research, followed all the rules 100%, read anything and everything we could so we were fully educated on the subject then Mexico is an excellent option. I had mine done in Mexico and not one problem whatsoever, was I scared yes but there's no way I would have been approved here so that was my only option. I hope this all works out for you and keep in mind this is only my opinion but there's no way I would try to fight the insurance company as it could take months or even a year to get approval and that's an if I wouldn't want to gamble with. Best of luck!

[thicknsweet]

start researching now which insurance companies would approve your surgery and switch to them during open enrollment if you dont want to do it in mexico. anthem paid for mine with a bmi of 36 and high blood pressure.

[RehabNurse]

start researching now which insurance companies would approve your surgery and switch to them during open enrollment if you dont want to do it in mexico. anthem paid for mine with a bmi of 36 and high blood pressure.

Yep. I had Blue Cross/Blue Shield of Texas and they approved the surgery with a BMI of 37 and a comorbidity of dyslipidemia (elevated cholesterol). However, since this was a 90/10 coinsurance plan, I still had to pay $4,500 out of pocket even with health insurance coverage.

I was sleeved here in the U.S., but would have saved time, money and hassles by bypassing the red tape and traveling to Mexico to have the surgery.

[Alycat]

Did you have your surgery in Mexico? If so, how long were you there for? You actually have me considering it and I never thought I'd travel that far but that's what I'm willing to do if I have to. I'm just wondering what the whole process entails. I'm also wondering how soon I could have it done if I go that route. Thank you for all your information. It's so nice to have a place to talk to people who actually understand my struggles and what I'm going through.