litalo

kind of typing through the tears here...after having one center tell me that not only was my CIGNA plan covering the VSG in full, but even at a 3 mo instead of 6 mo turnaround, the doctor who I finally chose to move ahead with discovered that my actual policy has an employer-imposed bariatric exclusion. I was supposed to meet with the surgeon on Friday. This was all supposed to be pre-screened three weeks ago when I made the appointment with him, or at least discovered a month and a half ago when the other ins. coordinator supposedly contacted CIGNA. To rub salt in the wound, when DH asked the HR rep about if it was an across the board exclusion, or if there was a better policy he could get at open enrollment (next week), she said that bariatric services aren't medical, so they don't cover it. (more tears. i'm not in this for the smaller jeans; its the very real Type 2 diabetes, the high blood pressure, and various other metabolic issues that somehow aren't 'medical problems.' And the biggest crime in this? He works for a NA Casino of a tribe who has rampant issues with diabetes and obesity. And its a casino that brings in money hand over fist, yet they can't take on the extra liability of the surgery to make their employees healthy (I don't know however if the tribal insurance covers bariatric services. that would be an even greater slap in the face) so i'm trying to come up with plan b. Right now, I am very nervous about Mexico. Mainly due to the follow up and what would happen to us financially if I had any surgery related complications. Our policy excludes ANYTHING to do with bariatrics. So if I had a complication with my bariatrically modified stomach or health, I have a feeling that it would not be covered. (DH will ask this specific question to the CIGNA rep at open enroll next week) (I once had spasmed my jaw muscle trying to bite a small apple in half--don't ask it was to appease two fighting children in the backseat of the car who both wanted the one apple. My PCP coded the paperwork as a TMJ spasm, and the office visit was denied because even though it wasn't a TMJ issue, it said TMJ on the paperwork). another brainstorm i had was getting my own BCBS plan and running the surgery through that. There wouldn't be any savings on the monthly premiums, so it would be a big monthly expense to add on. And that isn't even factoring in taking preexisting obesity (now that that is a medical diagnosis they recognize) or type 2 into consideration. am i grasping at straws here? is mexico my only option?

thank you all for the encouragement and helping me see outside the box here. This news hit me like a load of bricks and it's been a pretty horrible day. I didn't realize about the medical financing and the alternative coding, and shopping in different markets. I'm in Southern AZ, and while my surgeon of choice is very good (and is a leader in VSG from what his resume says), i can probably look into Phoenix, So. Cal or Texas. All of which would be very reasonable for travel. really. thank you so much for the other things to consider. i appreciate a little glimmer of hope and some commiseration.

super awesome for you. i don't have that option as I am self employed and am already on my husband's insurance.

this is all good to hear! I just went for the first seminar with Dr. Chassion and I feel that this is the right practice for me.

Hi all! This is my first post as I am just going on my first informational seminar this Saturday. It is a weight loss clinic that mainly promotes Lap bands, but also has bi-pass and the Vertical Sleeve as services offered. The VS surgeons that i am mostly interested in were booked (or I was booked) until August for seminars, so I decided to go check this first place out even though I'm not feeling it with them. Any tips or insights I should consider when attending these seminars? I haven't received a referral from my PCP or my Endo, though both have suggested I consider WLS in the past 2 years (as I had lamented about weightloss and diet upon diet that i could not make work; the d/g of hashimotos hypothyroidism two years ago hasn't helped either!) So i don't think there will be resistance on that front. But I do wonder if it is better for insurance to have the Endo or the PCP be my contact doc for the surgeon? so much to think about and i am very excited about the VS! I really feel that this is the best choice for me after doing much reading and thought about the options. Thank you in advance for your input!