Just Decided To Have The Sleeve Done...where The Heck Do I Go From Here? Help!

[kcarroll 4]

My name is Kendra, hi all! (:

I literally just decided to have the sleeve done. This is pretty exciting moment for me. I have thought/fantasized about having wls, but never really did anything about it. I guess it just always so risky. After doing some research about the different kinds of wls, it seems to be old hat for a lot of people. So, I figured if they can do it, so can I!!

But...I have no idea where to go from here.

I am 29 and I recently moved out of state for work and am living in Philadelphia. No family or friends in the state, so this should be interesting to say the least! First thing I did, last night at about 10pm (told you I literally just decided) was check with my insurance provider to see if they cover wls and voila! They cover 80%, which is a good thing, I think.

The next step- Find a doctor and tell him I want wls? Is it really that simple..and by simple, I mean probably one of the most difficult things I've ever had to do!

I know that once I find a doctor and we've talked about it, as well as all the options, and cons and pros, that everything will seem a little more on track..but for right now.. what happens next? How long is the process from this point until surgery? I've read about special diets that doctors put you on before the surgeries.. What’s all that about? I've also read that you have to talk with therapists afterward?

I have tried to narrow down pricing for the sleeve as well. I realize that a lot of factors are involved with a surgery like this, but can anyone give me actual pricing?? I've read that it can be anywhere from $10,000-$13,000, while another website said $17,000-$25,000!! WHAT THE HECK!! Clarification.. That’s what I need!! So, any help at all, would be wonderful!

[Wheetsin 714]

Man, I need to go buy some glasses or something.

You will need to decide what's going to drive your decision on surgeon: local, insurance coverage (in vs non network), or experience, etc. A lot of people covered by insurance gowith whomever's the closest to them. I personally found a handful who were close enough and went with the one I felt was the best surgeon.

You also need to find a surgfeon who will take the insurance that you have. Your provider's website should have a searchable directory. The surgeons may or may not be listed as bariatric surgeons. There are also directory maps all over the place, here's one to start.

The length of the process depends on two things:

1. What your insurance requirements are

2. How busy/quick your surgeon's office is

(Ok, it can depend on a LOT of things, but those are your two primaries)

There are different kinds of "special diets". One is an insurance required 6 month diet. (There are variations but this is the standard). Your surgeon puts you on it because your insurance won't approve your surgery without it. When I said "found out what requirements are" above, this is one of the things you will need to find out about. You CAN just go to a surgeon's info seminar and trust the office coordinators to do this research for you, but IMO you're 100% better off if you find out on your own. All it takes is a call to your sinsurance company, or a read through your SPD, or having them fax you the requirements... whatever gets you the info.

The other kind if special diet is a "preop diet" that often, but not always, consists of about 2 weeks on sugar free liquids. It's basically to prep your body for the surgery. I didn't have to do it (either time: I've had two WLS) - mine was 2 days of sugar free Clear Liquids. Some people have to do a diet of shakes and small meals. The "usual" diet is the 2 week liquids one.

Insurance approval usually requires 1 - 3 meetings with a therapist before your surgery (more if needed) and 1 - 2 afterward. The afterward will be dropped before the before ones are. It's very standard and just ensures that you're in a good place, mentally (in a comprehehnsive way), and prepared for the surgery.

There is no single price for the surgery (like there's no single price for anything else). A haircut here is $7, a haircut there is $50. My surgeon charges about $13k. That's for SELF PAY, that's not for people with insurance. I believe his rate is fairly competitive, and is definitely one of the lower self-pay rates in my area.

Start with our insurance requirements, and with finding a surgeon you think you'd like to work with.

My name is Kendra, hi all! (:

I literally just decided to have the sleeve done. This is pretty exciting moment for me. I have thought/fantasized about having wls, but never really did anything about it. I guess it just always so risky. After doing some research about the different kinds of wls, it seems to be old hat for a lot of people. So, I figured if they can do it, so can I!!

But...I have no idea where to go from here.

I am 29 and I recently moved out of state for work and am living in Philadelphia. No family or friends in the state, so this should be interesting to say the least! First thing I did, last night at about 10pm (told you I literally just decided) was check with my insurance provider to see if they cover wls and voila! They cover 80%, which is a good thing, I think.

The next step- Find a doctor and tell him I want wls? Is it really that simple..and by simple, I mean probably one of the most difficult things I've ever had to do!

I know that once I find a doctor and we've talked about it, as well as all the options, and cons and pros, that everything will seem a little more on track..but for right now.. what happens next? How long is the process from this point until surgery? I've read about special diets that doctors put you on before the surgeries.. What’s all that about? I've also read that you have to talk with therapists afterward?

I have tried to narrow down pricing for the sleeve as well. I realize that a lot of factors are involved with a surgery like this, but can anyone give me actual pricing?? I've read that it can be anywhere from $10,000-$13,000, while another website said $17,000-$25,000!! WHAT THE HECK!! Clarification.. That’s what I need!! So, any help at all, would be wonderful!

[Erin6573 10]

I went the self pay route and it was $11,200 which included the hospital stay and my surgeon's fee, plus a years worth of follow ups with him. If you go with your insurance, you will likely have a lot of requirements to meet like diet documentation for so many months, and a BMI of a certain range for so many years. When you find a surgeon, their insurance specialist can do the insurance research for you, or you can just call the insurance company and ask them yourself. My surgeon is in Michigan, as am I and he does a lot of out of town patients because of his pricing. Good luck to you.

[kcarroll 4]

Thanks Wheetsin and Erin!

Quick question.. Self-pay...what is it?

[former_vbg 198]

All good feedback for you so far, but something else I want to add on cost is that if you go through an approved Dr. in YOUR insurance network, those doctors will have a contracted rate of pay. But, as you seem to already understand there are other things involved in terms of cost. There will be the anisthesiologist, hospital bill, meds, etc.

As suggested to you, find an hour sometime to call your insurance company where you can have a list of questions for that rep, document who you spoke to, date, time, etc. Find out what your max out of pocket deductibles are, etc...

Each insurance plan is going to have their own requirements as already suggested and be sure you request documentation on exactly what that is. I do NOT suggest relying on any doctor's office because more often than not it will cause you issues with *something* getting missed. You MUST be your own advocate throughout this entire process. This includes the process of getting the surgery.

Congratulations on moving forward to a healthier you!

[sleepeone 23]

Wow, first Kendra breath and relax. One of the hardest decisions is making the decision & committment to which ever WLS is best for you. You've already made the decision to have WLS so now you can proceed just remember to continue to ask questions.

Every WLS is different for each person so what I tell you or what you read on post/blogs are of course only our experience and opinions. We are not replacement for medical advise.

You should be able to go to www.obesityhelp.com/find/bariatric-surgeon/PA/ which should give you the weight loss surgery doctors in Philadephia area along with reviews and doctor data.

As far as pre-surgery diets, psche evaluations, or talking with therapist ; that is going to be determined by a number of factors, which doctor & his requirements, what requirements your insurance co might require, your own personal needs. (I myself , I'm in north louisiana, had my sleeve surgery 4 weeks after my first visit with the doctor, only had to do 1 week before the surgery pre-op diet, never had to do psche evaluations or talk to any therapist.... I had to talk with nutrionist and my surgeon has a private Facebook support group that I actively keep up with)

The price of sleeve is going to be dependent on where you have it done location city wise, the surgeon, the hospital, etc. Knowing your insurance covers 80% is great. (My insurance also covered 80% and if I remember right my out of pocket was around $2,500.00 for everything, surgeon, hospital, anesthesia, xrays, lab )

Whatever WLS you and your doctor decide on will be a life long tool for you to lose the weight that prevents you from living fully, but it will be a change so like I said before always ask questions , get as much information that pertains to you personally as you can get. WLS can and will change your life.

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[former_vbg 198]

Thanks Wheetsin and Erin!

Quick question.. Self-pay...what is it?

You pay ENTIRELY out of your own pocket. Doctors will give self-pay patients a better rate because they don't have to go through all the paperwork and red tape. Most often you can skip the 6 month supervised diets, gathering of years of weight history, etc. Your doctor will still probably have you do some routine tests like an endoscopy, bloodwork and some other things but not NEARLY as extensive as if you have to jump through all of the hoops and hurdles of getting approved through the ins. company.

[Wheetsin 714]

Self-pay means you're paying for it out of your own pocket. Usually people self-pay when their insurance doesn't cover it, or they just don't want to deal with the hassle of insurance. The difference in self-pay versus contracted/non-contracted rates are crazy.

E.g. as I mentioned, self-pay through my surgeon is about $13k. I think $12,999. So I could write him a check for $13k and that covers everything, start to finish, and a year's worth of post-ops (post-operation visits).

My insurance company was billed something like $47,000. My insurance company actually paid something like $6200.

Needless to say, surgeons like self-pays!

Thanks Wheetsin and Erin!

Quick question.. Self-pay...what is it?

[kcarroll 4]

Okay, so my next question........ Self-pay.. Do you have to do that all in one shot, or can you make payments.. I have some savings, but I don't have enough to write a check for $13,000 and be done with it!!

Self-pay means you're paying for it out of your own pocket. Usually people self-pay when their insurance doesn't cover it, or they just don't want to deal with the hassle of insurance. The difference in self-pay versus contracted/non-contracted rates are crazy.

E.g. as I mentioned, self-pay through my surgeon is about $13k. I think $12,999. So I could write him a check for $13k and that covers everything, start to finish, and a year's worth of post-ops (post-operation visits).

My insurance company was billed something like $47,000. My insurance company actually paid something like $6200.

Needless to say, surgeons like self-pays!

[sleepeone 23]

Many surgeons that offer "self-pay" will also offer payment plans, I know mine does. Again you will have to check with the specific doctor that you choose.

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[Wheetsin 714]

Depends, really. I think most set up payment plans, but I have heard of some people who are required to pay in full up-front. There are also medical financing companies, but I couldn't tell you the names of them.

A lot of self-pay people opt to have surgery in Mexico. Mostly because of the price difference, but also because the surgeons there do a lot of procedures. I don't know if they do more than the busier US surgeons, but they defnitely benefit from the undercutting. I believe MX surgery is in a range of $3800 - $6000. The people who do MX still need to find a US surgeon in the event of complications (I guess they could travel back to MX but I don't think that's a very popular option).

I had a sufficiently annoying insurance fiasco and had decided that if I didn't get my approval by 3.1.2012 I was going to self-pay, but I was going to stay with my surgeon. I have good insurance and a large selection of surgeons, mine is who I've elected to have cut me open so it was worth the $ to me. I would have paid in one lump sum so I didn't even ask about financing. My approval ame through early Feb so I lucked out.

Okay, so my next question........ Self-pay.. Do you have to do that all in one shot, or can you make payments.. I have some savings, but I don't have enough to write a check for $13,000 and be done with it!!

[former_vbg 198]

Okay, so my next question........ Self-pay.. Do you have to do that all in one shot, or can you make payments.. I have some savings, but I don't have enough to write a check for $13,000 and be done with it!!

I don't know what the percentage is of doctors who accept payments, but I would be surprised to find it that high. They run a high risk of patients defaulting, i.e. not getting paid for their services plus them paying for the hospital costs. I would venture to say most doctors want to be paid up front. There are various companies out there that specialize in medical loans if you decided to go that route. Or, you could take a loan from your 401K (just check to see what your plan rules are if you left your job). Some 401k plans, you have to pay a loan back w/in 60 days of leaving the company. My company lets you continue making payments even after you leave the employer. Each plan is going to be different.

Honestly, if you have insurance, I wouldn't be spending my time worrying about self-pay. Take this time and call your insurance company and get the ball rolling there.

[Pookeyism 1,143]

I did not go the insurance route, but I suggest you read and read and read on here - there are alot of people who have kept track of their journey - what to-do's as well as what not to do!

Understand your insurance, and confirm your specific coverage does not have a exclusion on the surgery. If you work for a large enough company and are comfortable with it, ask around and see if anyone in your company can help you out with info.

START SAVING - this costs more than you think and alot will be out of pocket for you (most likely). You will also want to purchase books and miscellaneous that having extra will help alot.

If you are covered, if there is no exclusion, find a doctor that all of his support group AND hospitals, are all on your insurance plan. Check also to see if maybe your insurance has a package deal with someone already.

Get the costs from you doctor up front as is you DID NOT have insurance, and then compare to what is quoted for insurance. This is a neglected step in many people's journey - and remember as you go forth so shall you blaze a trail - future sleevers benefit from this too...do not go to a doctor that would charge the insurance more than a cash customer. I sugget it, at least. It speaks to the ethical nature of the doctor.

Know your limits on, realistically, how long you need to save on your end. You need enough for your percetage, trave, copays, out of poclets, foods, supplements, etc...and also to supplement your pay from missed work - possibly longer than you think...coming from experience, dont eat up you emergency funds! You would be suprised at what can happen while you are thinking you are going to have some quiet time to recover.

This was all I can suggest, the actual process seems to vary, and I was self pay. Good luck.

[kcarroll 4]

HOLY CRAP!!! Thanks to everyone who read and put in their two cents!! All this info is awesome, and please... KEEP IT COMING!! My next step, reread every post, write questions and call my insurance co back.. Ha, I pity the person who takes that call (:

THANK YOU, THANK YOU, THANK YOU!!!!!!!!!

[Wheetsin 714]

Oh, when you call your insurance company it will help to know the CPT code for the surgery. 43775. So when you call and tell them you want to check on the requirements for a surgical procedure, tell them you have the "CPT code for the procedure" and then give them that number. They'll probably confirm it with you. They also aren't going to call it a "vertical sleeve" so the procedure name (wht they will see next to that code) is: Laparoscopy, surgical, gastric restrictive procedure; longitudinal gastrectomy (ie, sleeve gastrectomy)

It always throws me off when they throw out the procedure name, and I'm used to a much more colloquial name. I'm always like, "I think that's it, can you say it again more slowly?"