5DogMa

I was told they base it on your weight when you start with the bariatric surgeon since most doctors will require you to lose some weight before surgery. Then I've also heard the same as above. Wear ankle weights to keep your weight up. Why can't we get straight answers out of our medical insurance companies!!!! When I started I was 42 BMI now I'm at 38, but then after all this testing found out I had 2 co/morbs so I'd still qualify. Since I don't trust my insurance company to tell me the truth, I'll be sure not to fall below 35 BMI to qualify.

I have BCBS of LA. I have found out that what it says on line when you check, and what they tell the customer when they call in to check on their benefits, MAY NOT be what they tell the doctors office when they submit for approval or call in to verify coverage. I had verified on line and even printed out the content from the web site. Then over the phone verified at least 3 times with 3 different people there was NO 6 month waiting period to have VSG if you met the criteria of 40+ BMI. I was 42 BMI. Then they told my WLS I have to have 6 consecutive monthly office visits! I am so mad because if they stick to the 6 consecutive month weigh ins and doctor visits it pushs my surgery out until January which means I'll have to pay the max out of pocket AGAIN! This year my max out of pocket was $3,000 which I have already paid because of all the testing, but next year it goes up to $4,000 out of pocket! That means my share of cost would be $7,000!!! I am told by my doctors office this happens a lot. So be careful. I am going to appeal if they deny coverage for this year. My WLS submitted yesterday for approval so we'lll see. Until then my bloodpressure will be elevated. Oh, my co-worker using the same insurance did NOT have to wait 6 months. :banghead:

I have BCBS of Louisiana. They told me NO 6 month wait period 3 different times by 3 different people when I called in to verify coverage from the beginning to check on this. That was February of this year. Then when my WLS office called they said 6 months consecutive visits! My first WLS visit was in May, then I went in June, I didn't go in July because I was moving, but went in Aug, Sept, October. I have a pre-op Nov 17 and surgery penciled in for Dec 7th. There is a chance they will deny me coverage! Even after my WLS told me this I called them and again they said NO 6 month waiting period! This was in August.. Criteria was BMI 35+ with co/morb or BMI 40+. My BMI was 42. Then with all this testing they found 2 co/morbs so I could drop below 40. My co-worker had WLS 2 years ago and did not have a 6 month wait period. I am really upset about this. I have met my max out of pocket because of all this testing and if I have to wait until next year it will cost me another $4,000 out of pocket!!! This sucks out loud!! Anyone else have this kind of thing happen? If I had known this I would have went to that July appt between all the moving. My WLS is sending in for approval this next week. URGH!!!!

Can I ask what agency you used to book your surgery? Thanks!

I am really feeling fustrated and discouraged! Everything is taking so long! I've been at this a long time going to my first seminar in February. It seems like my whole life this year has been about getting this surgery. I have gone through so much already and now the doctor wants 2 more tests. Upper GI and thyroid panel. I've had so many tests that cost thousands of dollars it's crazy to the point I think they are trying to discourage me from having the surgery. sleep study, endoscope, colonoscopy, various heart tests including a nuclear study, ekg, xrays, labs and more labs, dietian, psychological evaluation "Let's see how much more we can put her through until she gives up." I'm 57 years old so maybe they are extra careful??? Now, I'm starting to doubt if I need the surgery since I am loosing weight on my own. I am penciled in for December 7th for VSG pending the outcome of these lastest tests and insurance approval. I'm not worried about insurance approval since I meet their criteria. More time off work and more $. This hospital wanted my 20% upfront to do the Upper GI test. They took the money out of my account before I even had the proceedure! Wow, so if you didn't have the $170 up front I guess you wouldn't get the test. I bet the hospital will do the same thing when/if I have the surgery. I've almost reached my maximum out of pocket for the year because of all these tests so I don't have much more to pay out. If it gest pushed into next year I'm not going to have it done. They don't make you go through all this in Mexico!!

BettyBoop, I'd have to pay all that money $3,000+ again if it gets pushed into next year. I have a $3,000 max per year out of pocket for 2011 which I have met this year because of all these tests. Next year my max out of pocket goes up to $4,000 so I would end up paying a total out of pocket of $7,000 for this surgery. I could have gone to Mexico and self paid without all these tests. It's him, not the insurance company. The other doctor said I had taken all the tests he required. Then he left the private practice to go work at Kaiser. I got turned over to this doctor, his partner who has been in private practice for many years. He's the one who wanted more tests. I know this doctor has many years experience and has a good reputation. I can't image what else he could possibly want. It has to be this year or not at all for me. I'm helping my 29 year old daughter get this surgery in Mexico next Jan-Feb. She doesn't have insurance. What little money I have left that I saved up I'm giving her to help her pay for her surgery. I'm hoping she won't have to live her life like I did by getting her this tool.

He's the only one that does VSG near Sacramento that my BCBS PPO has a contract with. Then his hospital doesn't have a contarct for bariatric. URGH! The other doctor doesn't do VSG at that was Dr. Laura Machado.

It was the doctor who wanted the tests, not the insurance company. Overly cautious, YOU THINK?

Please let us know your experience with Dr. Garcia and the accommodations. Thank You!

So what happened? Did you choose him? I checked him out and he got good reviews on Obesity Help. He's been doing it a while and looks like he has the experience and credentials.

How much does Dr. Garcia charge for VSG?

Ah, thanks for the reply. My insurance doesnt know what it's doing. Now they say I can use several doctors. Anyway, I am scheduled December 7th with Dr. Patching in Sacramento. However, my daughter has decided she wanst to get VSG also but does not have insurance so we are looking at Mexico. Tell me if you would please, have choosen a doctor there and how much it will cost. I'm hearing anywhere from $5,000 to $7,800. Big difference and I'm wondering why. Thanks in advance and I wish you much success in your journey.

Go for it girl. Why spend the best years of your life miserable on yo-yo diets and spend thousands of $'s on diets that don't work. I'm going to help my daughter who's just like you but she's 28 years old get VSG next year. Why should this surgery be limited to the morbid obese with other health issues. Do it now before you get those health issues or you lose your self confidence because of your weight. Just know this is very serious and a life long committment. Not a fad or quick fix and you can complicate and ruin it and gain back the weight. Long term weight loss will all be on you, not the surgery. It's just a tool to help you get there and stay there IF you are willing to stay the course and change your lifestyle. Good luck to I hope it works out. I am scheduled to have VSG December 7th and I know I'm going to wish I had it done sooner.