Michelle Tarver 62 Posted October 15, 2015 I did,and I am so sad. I started this process in March 2015, I had originally hoped to be surgically completed and back to work before I was supposed to go back from an injury I had at work. That plan didn't work out despite not getting back to work before August.( Thanks Atena you suck) So plan B was have procedure in February.2016. For a lot of reasons now that won't work. I am about a 42 bmi now...So a 10 lb weight loss knocks me out of the 40 BMI range to qualify for the procedure. My next plausible window for the procedure is Dec 2016 I can't live in this body that long without going nuts. So,I am going to have to switch to the medical weight loss program. I cried when I told the NUT today. And I am crying writing this. Best of luck to you all. Thanks for all the support. Share this post Link to post Share on other sites
Linaka 92 Posted October 15, 2015 I don't understand... Eat pizza, wear ankle weights! Don't give up! Share this post Link to post Share on other sites
Mom26 313 Posted October 15, 2015 This is heartbreaking. Can you share why February is out of the question? And if not February, what about March? April? From what I understand, as long as you're over 40BMI at the time of your first appointment, that's the weight used for the insurance approval. Not familiar with your insurance though. Share this post Link to post Share on other sites
Michelle Tarver 62 Posted October 15, 2015 It's basically work. I have had 4 work place injuries 4 years running. I have missed at least 6_8 weeks minimum on each occasion. February was when I would be able to get my full short term disability pay..but I still don't qualify for FMLA ,or a company permitted medical leave...the last one is to soon...it will be June or July before I do qualify,and it is to busy at work ..And would make me look bad to schedule an elective surgery then...After Christmas 2016 is even a little pushy..but I would want to make the most of my insurance deductibles having been met. Sent from my E6782 using Tapatalk For Aetna your BMI has to be 40 on surgery day... Sent from my E6782 using Tapatalk Share this post Link to post Share on other sites
BLERDgirl 6,417 Posted October 15, 2015 If I understand you correctly it's the work schedule that is preventing you? Can you stay in the weight loss program and maybe aim for next year for surgery if need be? At least that way you would have documented weight loss attempts. Either way, wishing you the best! Share this post Link to post Share on other sites
thisfathasgot2go 235 Posted October 15, 2015 Maybe consider self-pay so you don't have to go through hoops? Good luck! Share this post Link to post Share on other sites
OKCPirate 5,323 Posted October 15, 2015 @@thisfathasgot2go - no kidding, it was $2500 with co-pays and wasting a whole bunch of time, or going to Mexico for $4500 and no waste of time...plus those people in Mexico would finance. And look the reality is that Mexico has a much lower infection rate than they do in the US. WHY? Private rooms. Big rooms. They mop four times a day. No extra equipment. Anyone who's been there no the quality of care is great, just different than the US. Not saying you have to, just offering options. Share this post Link to post Share on other sites
thisfathasgot2go 235 Posted October 15, 2015 I think self-pay is probably a nice tax deduction too. You should be able to deduct the medical expenses charged and transportation expenses to and from your appointments/surgery, if you itemize. You just need a doctor saying it was medically necessary and then save all your receipts. Note I am not a CPA. Share this post Link to post Share on other sites
Crssypooh 13 Posted October 15, 2015 I agree with OKCpirate. I went through all the hoops for a lap band back in 2011. After 18 months I had only lost 3 pounds following the instructions to a tee. I had it removed and planned on doing the VGS, but during the 6 months of doing the hoops all over again my bmi fell below 40 and I no longer qualified. I gave up. About 6 weeks ago I decided I wanted to do it. Contacted my insurance and found out my out of pocket would be $13k AND I still had to do all the hoops, so I reconsidered going to mexico. Started my internet research and two weeks later I was scheduled. Both my husband and I had the surgery on the same day a few hours apart and are recovering together. We had a suite together. I will admit I was scared, but it all went very smoothly. Share this post Link to post Share on other sites
Michelle Tarver 62 Posted October 15, 2015 Atena and it's every changing policy is what delayed it in the 1still place,yes and the stupid.40 BMI on surgery day rule is what if I let it keep me stuck fat until I have a good surgery window. I am pretty sure..thought it is Aetna and I would not put it past them to throw up another road block..that the insurance side is not my most pressing issue That is my window.of maximum opportunity to have the surgery done and health is so far away. I could.I suppose do the medical.weight loss till next fall and still go to Mexico for WLS. But if I do it in the US I have zero out of pocket..I have CHAMPVA as a.2nd insurance. I.was hoping to save Mexico for the plastic surgery.post weightozs Share this post Link to post Share on other sites
BLERDgirl 6,417 Posted October 15, 2015 Why not step away from this for a week? Don't think about or read about any of this and then come back and look at your options? Sometimes when I have crazy decisions to make taking a day to step back allows me time to calm down and I can often come up with a solution. Share this post Link to post Share on other sites
Dub 9,922 Posted October 15, 2015 I gave up, too. I gave up on the insurance company. Never gave up on having the surgery. There are ways to self fund it, you may have to get creative. Have some discussions with the Bariatric Centers in your area and find out what the self-pay cost is. You may be very pleasantly surprised. Please don't give up on the procedure. Share this post Link to post Share on other sites
notgonnabelikemymom 12 Posted October 15, 2015 Do you have a job that includes federal holidays? Or basically has some sort of time off already built in to the schedule? It takes about four nights to have surgery in Mexico and depending on your job you could head back to work fairly quickly. And like someone else said, there are finance options with some of the brokers that offer all-in-one deals to Mexico. Just something to think about. Share this post Link to post Share on other sites
Proud2BMe 1,016 Posted October 15, 2015 Michelle, It really bothers me when people just give up without exploring every option that is available. Save up about 6-7 thousand dollars and go to Mexico and have your surgery. We have an entire sub-forum on it. I saved up for 8 months to have my surgery in Tijuana simply because I didn't want to jump through the hoops of insurance companies. It was worth every penny. Don't give up. Just be creative and think outside the box. Share this post Link to post Share on other sites
The Candidate 3,215 Posted October 15, 2015 You say you have "a next plausible window" so I say go for it! It is so worth it! Share this post Link to post Share on other sites