Im just beginning and have a ton of questions

[stuffystephie 1]

So to start this off im 27 and a single mom to a 9 month old princess who is the absolute apple of my eye. She is the whole reason i have decided to finally have the surgery. I am all she has and i cant quite see myself keeping up with her at 260lbs. I have been considered obese since i was a kid...done everything u can think of to lose the weight too.

In any event i just found out that i have high cholesterol now as well.

I have anthem blue cross as of jan which covers bariatrics at the centers for medical excellence. We have an hra plan with an fsa as well. My ins covers me at 80% when deductible is fully satisfied....anyone have any experience with anything like this?? I set aside some funds for the fsa to specifically help with the surgery but struggle financially as it is but i just know this is something i need to do to get my life back.

Any advice or info would be helpful...

Would they speed the process up since i already have some significant health risks due to my weight??

[pgkpjs 113]

Yes, I have Anthem Blue Cross and with them you either need a BMI > 40or have BMI > 35 (? not sure about the exact number here) and have co-morbidities like high cholesterol, blood pressure, diabetes or sleep Apnea. For obese persons, there is a good chance of having sleep Apnea so if needed you could test for that. I would suggest planning so most of the pre and post surgery is done in one year to maximize deductible and benefits.

The cost is not insignificant but I planned it when my family was already close to the deductible and with my BMI > 40 and with the co-morbidities it was a quick approval with no pre-approval weight loss required. My total out of pocket ended up being about $1200.

[stuffystephie 1]

My bmi is definitely far over 40 im at 47 and i have high cholesterol now too which i just found out today from doing my biometric screening...i have an hra/fsa ppo plan with a 3000 deductible but the surgery cost alone combined with my hra will meet my deductible. But being that its something that would be potentially deemed medically necessary would my ins still only cover me at 80% or would it be fully covered?? They wouldnt go beyond what my plan allows right?

[pgkpjs 113]

It has to be medically necessary for them to cover it regardless. It should be considered necessary in your case. You will have to pay the 20% up to the annual out of pocket maximum. Make sure that the surgeon and his team including the internal medicine, psych, dietitian are in-network. Also ensure that both the hospital and the anesthesiologist are in-network as well.

Lets say your in-network out of pocket maximum for the year is $5000. No matter what, you should not have to pay more than that including the deductible and the co-payment as long as you stay in network.

If money is a big issue, plan on doing this in the same year as some other big medical expenses to offset the cost. You could look at the pre-surgery diets that people talk about on this forum. If you work at it you should loose some weight on it. A loss of 20-30 lbs will get your cholesterol under control. If you exercise it would help as well. It will all be good preparation for getting the band as you have to control what you eat and exercise when you have the band. Although the band does make it easier to eat less as it suppresses hunger and can restrict food you eat.

Start by pretending you have the band and go from there.

[stuffystephie 1]

Ok so my in network out of pocket max is 8000 and i have a 3000 deductible which would easily be met with the cost of the surgery and my hra...but the deductible counts as part of the out of pocket max? Im not very good with this insurance stuff at all i am trying and still learning but i think im getting better...

Its just really tough to be able to do a lot of things like exercise when half my day is spent working full time and i have my daughter 100% of the time as well so i need to go home to be with her and be in bed by 8 so i can be back up by 5 to start all over again...lol...

[pgkpjs 113]

I have twin two year old boys and my job is very demanding of time so I hear ya.

Yes the $3000 counts towards the $8000 maximum. Try the pre band diet, loose some weight that will help a lot regardless. The first 20 pounds made a big difference to my back pain, cholesterol etc. If you can swing it, do the band, if you can't, do some of the stuff that bandsters do -

64+ oz of calorie free fluids a day

60+ gms of Protein

Low fat low carb food

No refined starch or sugars.

Keep logs. Read on the forum regularly for ideas and motivation...

[stuffystephie 1]

Ok well now it makes a bit more sense to me i thought the out of pocket max was in addition to the deductible as in a separate cost kind of thing.

Being that i have spent my entire life (from roughly 6yrs old) being obese i think its time i for a drastic change and i know from a few people who have had it done who say it basically teaches you how to eat all over again more less....which i think would do me good. I honestly eat pretty healthy foods and i do drink a ton of Water so i just dont know what else to do. Thanks for the advice tho. I appreciate it :-)

[pgkpjs 113]

No doubt, I am adjusting to this new way of eating. I have lost weight before and put it back on and then some so for true long term weight loss I do recommend the band.

[CHEZNOEL 4,061]

Not much on insurance, but I can answer other questions for you.

[stuffystephie 1]

Is there a general cost on the surgery for the band itself or does it vary based off the doc and the hospital...im just trying to get a general idea of cost really...

What kind of diet do they put you on in the months prior to the surgery or is that something you just work out on your own?