Conflicted - approved and scheduled for RNY but thinking Sleeve

[KatieSue 0]

Hi Everyone -

I'm new to this forum. I've recently been approved by my insurance for the RNY which I researched heavily and was prepared to have. My surgery date is currently October 20, 2009 because of my travel committments at work. Recently I started checking into the sleeve which is not covered by insurance and now I'm confused. I think the sleeve may be for me but it's really hard to pass up on insurance paying and pay for the other out of my own pocket. Any thoughts? My instinct is to fork over the cash but my husband has concerns.

Katie

[Ruthi 60]

What are his concerns? Maybe someone here can help you enlighten him. Who is doing your surgery?

[*susan* 1,709]

Hi Katie, and welcome to our forums. I agree with Ruthi, what are his concerns? Perhaps we can help address them.

Prior to first getting banded back in 2006, I did look at RNY. I decided it wasn't for me because I didn't want my intestines rerouted and because I really didn't feel like I needed the malabsorption. For me, I can eat the right foods, I just eat them in too big of portions. So, I was more interested in a restrictive type of surgery than anything. The band and the sleeve are perfect for that. But, if you are someone who is unable to avoid sweets and such, then you may need the RNY for the malabsorption.

I completely understand that what insurance is willing to pay for can be a huge contributing factor. However, you also want to make sure you choose what surgery is best for you. Have you talked to your surgeon about this? Does he perform both types of surgeries? If so, then he should be able to delve into this further with you and help you decide what is your best option.

Also, if you do decide to go with the sleeve, you might consider having surgery in Mexico, as their rates are generally much cheaper than in the US. You will see that many of us on here had our surgery with Dr. Aceves in Mexicali, who in my opinon is the absolute best there is.

[kaykay 1]

Good advice already given. One other point, if you are someone who needs to take NSAIDS (anti-inflammatories) on a regular basis, the sleeve might be a better option for you. (Some drs don't like their sleeve patients to have NSAIDS ever either, but generally, it is generally considered by most to be ok to take the NSAIDS after you are healed with a sleeve, but NEVER with a RNY) Not sure if that matters to you, but if it does, that's one advantage to a sleeve.

[KatieSue 0]

What are his concerns? Maybe someone here can help you enlighten him. Who is doing your surgery?

Ruthi -

Although I've discussed the different surgeries with my husband, he hasn't attended any of the appointments or seminars with me so I think he just doesn't understand the differences and risks completely. Ultimately he supports whatever decision I make but of course would prefer I did not use up our savings or put us in debt. He thinks I'm fine the way I am of course. I have an appointment with a different surgeon to discuss the sleeve next week and I've asked my husband to come with me. That might help!!

[KatieSue 0]

Hi Katie, and welcome to our forums. I agree with Ruthi, what are his concerns? Perhaps we can help address them.

Prior to first getting banded back in 2006, I did look at RNY. I decided it wasn't for me because I didn't want my intestines rerouted and because I really didn't feel like I needed the malabsorption. For me, I can eat the right foods, I just eat them in too big of portions. So, I was more interested in a restrictive type of surgery than anything. The band and the sleeve are perfect for that. But, if you are someone who is unable to avoid sweets and such, then you may need the RNY for the malabsorption.

I completely understand that what insurance is willing to pay for can be a huge contributing factor. However, you also want to make sure you choose what surgery is best for you. Have you talked to your surgeon about this? Does he perform both types of surgeries? If so, then he should be able to delve into this further with you and help you decide what is your best option.

Also, if you do decide to go with the sleeve, you might consider having surgery in Mexico, as their rates are generally much cheaper than in the US. You will see that many of us on here had our surgery with Dr. Aceves in Mexicali, who in my opinon is the absolute best there is.

My surgeon and I haven't discussed the sleeve yet. I have a new appointment with him next week. He once said to me, if you were self-pay I would be recommending the sleeve but since you have insurance the RNY may be right for you. I am also seeing a second surgeon next week. Although I feel very comfortable with my surgeon I've found and been through the whole process with, I'm not sure how much experience with the sleeve he has. There is another surgeon here in Houston that has been recommended to me with more sleeve experience and better prices. My current surgeon is quite $$$ now that I may be a cash pay.

Its so hard to not only switch surgeries at this late hour, but also to think about switching doctors after working with him for 5 months now. Oh well - better to do it right than to rush.

I'm 5'4 and about 250 lbs and 29 yrs old. I feel my biggest problem is over-eating, I know what I should eat!!! But, my husband and I have also been enabling each other the past few years to eat what tastes good instead of what we should. So habits will need to be changed for sure but I still think the quantity is the biggest issue. I'm not a sugar junky but he is so its always in the house.

I've been reading a lot on this forum about the experiences with going to Mexico. I have to say I never considered it but now I'm curious and will have to do some more research. Thanks for the input.

Truly I think my husband fears me doing any surgery but will support me. So with his fear of me doing it in general, plus spending our money, he is just a little apprehensive. Again, he doesn't think I need to do anything!! Sweet - but wrong!! I hope him coming with me next week will help ease his concerns as well.

[KatieSue 0]

Good advice already given. One other point, if you are someone who needs to take NSAIDS (anti-inflammatories) on a regular basis, the sleeve might be a better option for you. (Some drs don't like their sleeve patients to have NSAIDS ever either, but generally, it is generally considered by most to be ok to take the NSAIDS after you are healed with a sleeve, but NEVER with a RNY) Not sure if that matters to you, but if it does, that's one advantage to a sleeve.

Good point on the NSAIDS. Although I don't have to take them, I prefer them for my back pain. I was struck by a car while walking when I was 15 and I've had 2 knee surgeries plus a recent back surgery and of course possibly more in the future if I don't get the wait off. I take a lot of Ibuprophen these days just to do regular things like laundry, gardening, etc. I asked my surgeon currently doing RNY about it and he said maybe after the weight loss I won't need NSAIDS for pain anyway. I thought it was a good choise but a big gamble. My husband asked if I thought that was smart considering my pain level. Good point hubby, you just gave me another reason for the sleeve vs RNY. I'll have to remind him of that.

I think he was comfortable with the band because we know a few people with sucess with that but the others scare him a little. His mother had WLS 25 years ago. I think the Verticle Banded Gastroplasty (early 80's). She lost 185lbs, never had any plastics and then gained back about 80 lbs. So - I think that is his experience with WLS surgery. I reminded him I don't have 185 lbs to loose and if I require plastics, well - I'll be getting them done!!!!!!!

Anyway - thanks to all for your advice!!!

[Ruthi 60]

Sometimes with insurance, you have to meet your deductibles and some sort of co payment. With the cost of surgery in the states, sometimes the co pay can be as much as the sleeve cost in Mexico if not more. That may be a consideration also. Men are notorious for worrying about the money issue but if you were lying in a hospital ICU because of a cardiac problem, he would regret his hesitationbecause of money. The surgeon's experience with the sleeve surgery is also a MAJOR factor.

[DownInSocal 12]

Welcome Katie.

I understand about money worries. I am an Accountant and as tight as they come. You know what?

YOU are worth it.

YOU need to get the surgery YOU want. Not what your insurance wants. If that means self pay then self pay it is.

I am getting the sleeve because when I started this journey I was 212 down from a high of 223. I am 5'3 almost 5'4. RNY seems a bit drastic to me. You have a few more lbs but not much compared to some who need to lose 200 or more lbs.

I would have been anti-Mexico at first but Aceves seems to have so much success and happy patients. I would look into it.

Please keep us updated no matter what you choose. I love hearing peoples stories, good and bad.

[KatieSue 0]

Sometimes with insurance, you have to meet your deductibles and some sort of co payment. With the cost of surgery in the states, sometimes the co pay can be as much as the sleeve cost in Mexico if not more. That may be a consideration also. Men are notorious for worrying about the money issue but if you were lying in a hospital ICU because of a cardiac problem, he would regret his hesitationbecause of money. The surgeon's experience with the sleeve surgery is also a MAJOR factor.

So true Ruthi about the worries. I'm definitely leaning towards self-pay. As far as my insurance - I have pretty good insurance. Max out of pocket is $2000 per year and $250 deductible. With going through the approval process already, I've met the deductible and would have to pay another $1300 at this point for the RNY. So - comparing $1300 to $13,500 is what's getting Steve. But - as others have said - its about what is best for me, not what insurance will cover. Thanks. again.

[KatieSue 0]

The second doctor I am seeing besides my surgeon soon is Dr. Alanis in Houston, TX. Anyone have experience - good or bad with Dr. Alanis? My current surgeon for RNY is Dr. Garth Davis. Anyone had a sleeve with Garth? I'm meeting both docs for sleeve consults soon.

[DownInSocal 12]

So true Ruthi about the worries. I'm definitely leaning towards self-pay. As far as my insurance - I have pretty good insurance. Max out of pocket is $2000 per year and $250 deductible. With going through the approval process already, I've met the deductible and would have to pay another $1300 at this point for the RNY. So - comparing $1300 to $13,500 is what's getting Steve. But - as others have said - its about what is best for me, not what insurance will cover. Thanks. again.

My primary is Aetna and secondary is TriCare Prime (Military). My primary insurance plan does not cover WLS surgery but they are paying for all my work ups. The doctor and hospital are putting them in as health work ups not pre surgical work ups. This might be the key to getting your insurance to pay for some of the pre testing and such.

[kaykay 1]

Another Mexican physician who seems to have a good reputation on the sleeve forums is a Dr. Guillermo Alvarez. It seems like his and Dr. Aceves patients are very well satisfied with their surgeries and care received. I understand that their prices are pretty comparable. Dr. Alvarez may be closer to you, however, if you are in Houston, but that's not a big deal really.

[KatieSue 0]

A question I have about going to Mexico for surgery is:

if you have later complications were you concerned about not having access to your surgeon in your area? What if I ended up in the ER for something and needed emergency surgery and my trusted surgeon is in mexico? Just trying to reconcile that with myself. And follow up care too? I realize not as necessary as it is with RNY or band but I'm concerned about not having access without great travel. Any thoughts? Thanks.

Katie

[Ky.hen 5]

Hi KatieSue and welcome to the forum.

I was in the same boat as you. My insurance will pay for lapband or bypass but not the sleeve. After checking out the pros and cons of these surgeries, I decided on the sleeve. I am self pay. I borrowed some of the money against my car to finance the surgery. My hubby was worried about the money at first too. We had a long discussion about everything concerning wls and he is in agreement with me now 100% about getting the sleeve. I will be going to Dr. Aceves in Oct. Cost 9,000 for everything.

I have heard alot of good things about Dr. Garth and I watch his show on tv all the time. Big Medicine.

I plan to give all the test results and reports to my family Dr. She has agreed to take care of all my after care. If I have a problem I can call Dr. Aceves anytime. If an emergency happens I will go to the emergency room and my insurance will cover it. Hope this helps.