Playing the Waiting Game: Insurance Requirements

[txblondgrl 0]

Hi all,

I'm a newbie to the boards, but I can tell I'm going to be here often! I've been trying to get my insurance to cover my surgery for about 2 years now and I finally got approval. In my prior attempts, they wouldn't cover it because I didn't have any co-morbidities. Ironically, I recently got diagnosed with hypertension and NOW my insurance will cover it. But...not until I jump through all their hoops. One hoop is that I have to follow a physician-administered weight loss plan for 12 consecutive months (and the doc has to sign a form for each month and they will verify records at the doc's office too). Well, that sure would have been nice to know a year ago when I first tried to get covered. So, anyway, now I'm playing the long waiting game. Since I've had the same doctor for a while and he knows how much I've tried (and struggled) to lose weight, we used some previous appointments to count in the 12 months. So, as of today, I have 4 months done and 8 more to go. *Sigh* Playing the waiting game is HARD! I also had to show 5 consecutive years of a BMI over 40. I have 4 and the previous year was just under 40 (only because I had just lost some weight from another attempted diet). So...I also have to wait those 8 months out to get the 5 year BMI qualification. And then, after all this, my deductible is still $5,000. So, I guess I have time to come up with the money at least! But waiting is HARD!

I'm currently over 400 pounds and am trying very hard to lose about 50 pounds (or more) before the surgery. Exercise is hard because I have some health issues, in particular with my feet, which prevents me from doing most activities involving standing and/or walking. I'll be 40 at the end of this year, but I feel like a senior citizen!

Anyway, I mostly came here for support and to vent about playing the waiting game. I'm ready for the surgery today!! Anyone else out there have to wait a while? Anyone else out there have these crazy insurance requirements?

Tks!

txblondgrl

[Bufflehead 6,358]

I don't know if this is something you are willing to consider, but if I had to wait 8 months and then pay $5,000 for this surgery, I would take that $5,000 and go get the surgery in Mexico NOW. Of course, there are drawbacks to going to Mexico (for example, you won't get the same follow up care and support as you would with your local surgeon) but for me, that would be my choice.

[txblondgrl 0]

Thanks bufflehead. I hadn't even thought of that. I think the idea scares me a bit. But, I'm willing to look into it. I don't actually have the money right now anyway. I live in TX, so Mexico is very close to me too. Hmmm...you've given me something to investigate and think about. Thanks!