Just Starting My Gastric Sleeve Journey, But Worried.

[NJsharon 119]

Hello everyone, I am completely new on here, but seems like a great board and so friendly! I am hoping to get gastric sleeve surgery for myself, but have not started any of the pre-op work yet. I am going to a information seminar (run by a local hospital) on Dec 7th and quite excited about that actually.

My worry is that I have Aetna and that I will not be approved. My BMI is about 38 and do not have any comorbidities - blood pressure is great, no diabetes & no sleep apnea. I had a sleep study actually & found that I snore a lot & wake up several times during the night (7 times an hour for 3-4 seconds) but no apnea.

I have read on the Aetna website that even if I gained some weight to get to a BMI of 40 I need to have had that for 2 years. So this worries me a bit.

Anyone used Aetna & been approved in similar circumstances?

Not sure I could self-pay, so really hoping I can get insurance to cover it!

That is all that worries me though, the thought of having the surgery does not actually worry me. I hope I can start this journey and be on my way as most of you are!

Oh and if I do have to do self-pay, is there a forum to help me find cheap NJ surgeons that would possibly do payment plans?

Sorry so many questions, but excited & worried!

[jasleeve 440]

welcome sharon! you have definitely found the right place to ask these questions!!

well, with most (maybe all) insurances require a BMI of 35+ with a co-morbiditie or 40+.

if aetna (which i hear is a real pain in the a$$) says that you need 2yrs history, than you will need that & if you dont have 2yrs of history stating you have BMI of 35+ with a co-morbiditie or 40+ with no health issues, you more than likely will not be approved. im sorry! you could always TRY but understand what may be ahead.

as far as self pay, you should talk to the receptionist at the hospital where you originally planned on getting the procedure done. also, you can research having it done in Mexico. it sounds crazy but sooooo many ppl do it & with the same drs. ive heard great stories.

do your research on it & see what are the best options for you! good luck

[Finding MeMe 204]

From the research I've done and If my insurance would not approve the surgery, I would definately self-pay. This is an investment in my future and my health, the 5,000.00 price tag would be well worth it to me. Good luck on your journey and I realize that no one can make that decision but you.

[Lissa 2,631]

Sharon, VSG is a big step, but it is SO worth it. You are smart to start working on this before you get hit with major health problems.

My advice is go to the seminar, talk to the doctor and his staff and TRY. If Aetna denies you, then you can look at alternatives. The doctor's office may have some ideas that will help you get approval.

If you just absolutely cannot get approved through your insurance, then look into all the other options: self-pay in Mexico, self-pay through the surgeon, Care Credit (and a couple of others) do financing for medical/dental procedures. Be careful, though, I understand the finance charge is high on Care Credit.

I did self-pay and was very lucky to have had the money to do it. My doc's office will let you pay on the surgery in installments, but it must be paid before surgery, and the hospital fee and anesthesiologist are both separate fees. My total was $12,500 for everything, including one night in the hospital.

Good luck with your journey!!

[gastricsleeve1-16-2012 0]

Hello sharon

i am also new on here. but i researched and my insurance just does not pay period. so i researched mexico. Dr ortiz, i am scheduled to have my surgery on 1-16 i am very excited but scared as well. The cost was less than half of what it is in the usa.