My dilemma

[ad1203 85]

Hi. This is the first time I am participating in a topic on this site. I just wanted to put my dilemma out there and see if I can get some advice. After being overweight for about 20 years, trying many different diets, like everyone else, I decided to do some research on WLS. After several months of looking into this and speaking with other WLS patients, I decided that the sleeve gastrectomy would be a great fit for me. After some more research, I decided on a bariatric group that I wanted to go with. I met with the surgeon last week. He spent about 45 minutes with me in his office discussing weight loss surgery. He also told me that since my BMI is 35 and I have no other issues, he would not be comfortable performing the sleeve gastrectomy on me. He recommended I go for the lap band surgery. I had already discussed this with my PCP, and she and I both agreed that I should not have lap band surgery. Since my insurance requires at least six months of weigh-ins and screening with other specialists (cardiologist, psychotherapist, sleep apnea doctor), the doctor suggested that I come in every month for a weigh-in and meet with these specialists for the benefit of the insurance company. My dilemma is, since I probably will not qualify anyway for the sleeve gastrectomy, and I don't want a lap band, what are my options? I don't know if any other doctors will flat out reject doing this procedure on me and if I should pursue it any further. To say I am disappointed is an understatement. I feel that the people who participate in these forums are pretty familiar with the procedures and requirements and could be helpful to me. Do you think I should just give it up now and try to do it on my own again, or could there be an alternative for me? I know the way I wrote this may be quite a ramble, but I hope I made some sense. Thank you for any advice you may offer.

Edited November 4, 2013 by ad1203

[belunos 93]

I can't give you advise, only impart what I know.

Other doctors will perform the surgery.

I highly doubt your insurance will pay for any of it due to your BMI and lack of comorbidities.

Many doctors are now refusing to do the band due to high post complication rates, so make sure you look heavily into it.

I keep hearing Mexico is a fantastic option if insurance will not cover it.

Sorry if this isn't what you're looking for, but hope it helps!

[ad1203 85]

Thank you. Any info that you may have is a help. I also have to say that while I was disappointed, I did admire and appreciate the doctor's honesty with me.

[magtart 603]

There is a whole section on this site for "Self Pay" options.

[ad1203 85]

Thank you. I realized after I posted that I put it in the wrong section. I couldn't figure out how to change it. I am a little technically challenged:)

[rae to a new life 3]

_{Well my BMI was 35 and then I was diagnosed with sleep apnea so my insurance covered it. For 5 months I thought I was getting the lap band and then I changed my mind because with the band you need to keep going back for adjustments and then you change your diet back to liquids after each adjustment. I didn't think this was for me so I decided for the sleeve and got it. Very happy I did. You get your sleeve and start your life step by step to each food level and learn to grow with your sleeve. The only negative thing is that I can eat sweets and not feel sick or have a side effect. I hear that gastric bypass patients just can't eat sweets ever or have dumping syn. So your own self control will need to be in place to not eat the sweets and gain weight back. Which is what I'm going to do. I tell everyone the sleeve is the best.}

[spunkyirishpunk 29]

Hope everything works out

[ad1203 85]

I was thinking of that myself (nuts, right?) There is always that chance that I could have a condition that would qualify me. Thanks for the thoughts!

[ad1203 85]

One thing I am sure of is I will not be getting the band. I just have to figure out the route to take regarding the sleeve. Thanks again!

[woo woo 872]

x

[ad1203 85]

Oh, I didn't know that. I was looking at the Mexico option, but my husband does not like that idea at all. I will start investigating that idea. Thanks so much!

[NMJG 1,266]

The type of medical center will vary the cost, too. Self pay in TX in a center of excellence can run $15k for VSG. Fortunately, my insurance paid (and required a center of excellence). My BMI had to be over 35 with comorbidities (I was 36 with high blood pressure, arthritis, high cholesterol). My dr. won't do lapband any longer. He did a ton of them but now only does sleeve and RNY. The ironic thing is that my blood pressure hasn't dropped despite my weight loss. I just have bad genes.

[Beach Lover 1,084]

If this doctor is not willing to do it then I would start thinking about changing doctors. Comorbidities will help get approval. Did your insurance company say no if your bmi was 35? Last time I checked this was still in the obese range and should be covered. The lap band is just a terrible idea and I would reevaluate if you want a doctor that would even suggest it. I wish you the very best!

[ad1203 85]

Thank you all. My husband and I were discussing it, and I think I will check out some other doctors first. I appreciate all of your responses and help!

[Fluffnomore 1,235]

My doctor originally said lap band for me as well. After really researching it I went back and said that I wanted VSG.

My feeling is that it doesn't make sense that he would be willing to do one, but not the other…unless he doesn't have as much experience with VSG.

Co-morbidities that will get you the surgery are diabetes, sleep apnea and high blood pressure. Others that are important but might not count with your individual insurance company are metabolic syndrome, arthritis, and GERD (although be aware that GERD is sometimes contraindicated for the sleeve; I had GERD and felt the benefits outweighed the risks).

Good luck and I'll be pulling for you!

ETA that my starting BMI was around 39. I didn't work at losing weight at all for that reason until the approval. I was approved on the first try.