Will I be able to get the Surgery

[SummerEssence 130]

Hello BP Pal's, I'm new to the site, I'm interested in getting the VSG and I have my consult on September 4th, 2018. I have struggled with my weight for 23 year now since I had my beautiful daughter. I am concerned that I might not be approved because, although I have struggled and been on many diets, exercise fitness plans personal trainer's you name it I've done it and even had the Gastric Balloon inserted in October 2017 and I did go from 212lbs to 194.8 losing only 17.20lbs and paying $8900 for it I really don't see where it helped me because if I look at food since having it removed in April 2018 I will gain weight. I am planning on self pay because I don't think the insurance will approve me since I do not have any ongoing health issues which is what I'm attempting to avoid, due to my mother having so many health issues due to her weight which finally took her life some years back.

I don't want to be sick and on all those medicines and the thought of this scares me to pieces, before she died she advised all of her daughters never to allow ourselves to get over 150lbs because it so hard thereafter, to get it off and boy was she telling the truth although, I wasn't at that weight when she passed away I was over 150lbs. I'm am currently 198lbs and 5"3 which makes me obese 35.2BMI, before having my daughter I was 131lbs and that was with two son's I had before her, I wanted to know if anyone know anyone that is self pay and if so around my stats that was able to get the surgery.

The surgery will cost me around $28k but I don't mind paying since I choose life over illnesses and medicines, I cannot imagine keeping this weight on I have to get if off and I truly need the help although I know this is only a tool there is nothing worst then eating clean and exercising 5 days a week 1.5hrs taking over 10k steps a day and not seeing any loss it truly is disappointing and make you want to give up but, I refuse to let this weight over take my life I will do what I have to do so that I can have a better quality of life and longevity.

Edited July 17, 2018 by SummerEssence
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[Sosewsue61 3,185]

Did you have sleep study done? Sleep apnea is a comorbidity. Does your insurance NOT cover bariatrics at all, or only with comorbidities? Or a certain bmi? Many say over 40 bmi w no comorbidities or above 35 with comorbidities.

At any rate, you could always go to Mexico for cheaper surgery. This surgery with its physical restriction is a great tool, you still have to work at it, but keeping the weight off will be much easier

[GreenTealael 25,439]

Hello BP Pal's, I'm new to the site, I'm interested in getting the VSG and I have my consult on September 4th, 2018. I have struggled with my weight for 23 year now since I had my beautiful daughter. I am concerned that I might not be approved because, although I have struggled and been on many diets, exercise fitness plans personal trainer's you name it I've done it and even had the Gastric Balloon inserted in October 2017 and I did go from 212lbs to 194.8 losing only 17.20lbs and paying $8900 for it I really don't see where it helped me because if I look at food since having it removed in April 2018 I will gain weight. I am planning on self pay because I don't think the insurance will approve me since I do not have any ongoing health issues which is what I'm attempting to avoid, due to my mother having so many health issues due to her weight which finally took her life some years back.
I don't want to be sick and on all those medicines and the thought of this scares me to pieces, before she died she advised all of her daughters never to allow ourselves to get over 150lbs because it so hard thereafter, to get it off and boy was she telling the truth although, I wasn't at that weight when she passed away I was over 150lbs. I'm am currently 198lbs and 5"3 which makes me obese 35.2BMI, before having my daughter I was 131lbs and that was with two son's I had before her, I wanted to know if anyone know anyone that is self pay and if so around my stats that was able to get the surgery.
The surgery will cost me around $28k but I don't mind paying since I choose life over illnesses and medicines, I cannot imagine keeping this weight on I have to get if off and I truly need the help although I know this is only a tool there is nothing worst then eating clean and exercising 5 days a week 1.5hrs taking over 10k steps a day and not seeing any loss it truly is disappointing and make you want to give up but, I refuse to let this weight over take my life I will do what I have to do so that I can have a better quality of life and longevity.

Medical tourism is always an option so don't count that out, it will leave room in your budget for plastic surgery. Be honest with yourself on whether you have food addiction, if so seek mental health counseling as well and you may consider a malabsorption/restriction surgery like RNY or DS for best longterm outcome as many people regain with VSG when they eat around it. Are you tracking your food intake with apps such as Myfitnesspal? Sometimes we think we are eating great and we aren't. Also see your physician and ask about endocrine disorders and slow motility. All things that could be a reason why the balloon didn't work and another light weight surgery won't either. Safe journey!!!

VSG2017 HW 249 SW 238 CW 169

[HealthierME2018 17]

Hi Summer Essence. I am in a similar boat as you- my highest weight was 236 (but that was the day I gave birth to my daughter 2 yrs ago). In the last year or so I have been between 200-215 lbs (before pregnancy I was 180lbs). I am at 210 now, I started my preop diet yesterday & am scheduled for VSG on Monday. My BMI is just under 35, but bc I am not a BMI of 40+ and I do not have any comorbidities, my insurance is not covering it. I am getting a hernia repair (covered by insurance) and they are doing the VSG same time, so I am only paying the difference, which is approx. $3,000 which is 100% worth it.

I do find it strange that so many people on this site say they paid 20-30K on these surgeries. I asked for the break down itemization and even if my insurance did cover it, it would only be between $12-15K. I see that we are both from NY, where would you be having your surgery that they gave you a quote of $28K?

I also was considering the balloon back in December and decided not to do it once my doctor stated that there is minimal long term success and they only usually assist with a small amount of weight loss.

[SummerEssence 130]

6 minutes ago, Tealael said:

Medical Tourism is always an option so don't count that out, it will leave room in your budget for plastic surgery. Be honest with yourself on whether you have food addiction, if so seek mental health counseling as well and you may consider a malabsorption/restriction surgery like RNY or DS for best longterm outcome as many people regain with VSG when they eat around it. Are you tracking your food intake with apps such as Myfitnesspal? Sometimes we think we are eating great and we aren't. Also see your physician and ask about endocrine disorders and slow motility. All things that could be a reason why the balloon didn't work and another light weight surgery won't either. Safe journey!!!

VSG2017 HW 249 SW 238 CW 169

6 minutes ago, HealthierME2018 said:

Hi Summer Essence. I am in a similar boat as you- my highest weight was 236 (but that was the day I gave birth to my daughter 2 yrs ago). In the last year or so I have been between 200-215 lbs (before pregnancy I was 180lbs). I am at 210 now, I started my preop diet yesterday & am scheduled for VSG on Monday. My BMI is just under 35, but bc I am not a BMI of 40+ and I do not have any comorbidities, my insurance is not covering it. I am getting a hernia repair (covered by insurance) and they are doing the VSG same time, so I am only paying the difference, which is approx. $3,000 which is 100% worth it.

I do find it strange that so many people on this site say they paid 20-30K on these surgeries. I asked for the break down itemization and even if my insurance did cover it, it would only be between $12-15K. I see that we are both from NY, where would you be having your surgery that they gave you a quote of $28K?

I also was considering the balloon back in December and decided not to do it once my doctor stated that there is minimal long term success and they only usually assist with a small amount of weight loss.

6 minutes ago, HealthierME2018 said:

Hi Summer Essence. I am in a similar boat as you- my highest weight was 236 (but that was the day I gave birth to my daughter 2 yrs ago). In the last year or so I have been between 200-215 lbs (before pregnancy I was 180lbs). I am at 210 now, I started my preop diet yesterday & am scheduled for VSG on Monday. My BMI is just under 35, but bc I am not a BMI of 40+ and I do not have any comorbidities, my insurance is not covering it. I am getting a hernia repair (covered by insurance) and they are doing the VSG same time, so I am only paying the difference, which is approx. $3,000 which is 100% worth it.

I do find it strange that so many people on this site say they paid 20-30K on these surgeries. I asked for the break down itemization and even if my insurance did cover it, it would only be between $12-15K. I see that we are both from NY, where would you be having your surgery that they gave you a quote of $28K?

I also was considering the balloon back in December and decided not to do it once my doctor stated that there is minimal long term success and they only usually assist with a small amount of weight loss.

Well, I don’t believe I have any comorbidities illinesses either and honestly I’m thankful for that. The place I’m going is located in Syracuse and the doctor is W. Graber.

[SummerEssence 130]

Thanks Tealael, but I think I’ll get mine in the states as money is no issue for me.

[GreenTealael 25,439]

Try anyway to see if your insurance will cover something, even as a revisions from balloon to which ever procedure you are going with. Check for hernias, GERD, everything EVERYTHING...

VSG2017 HW 249 SW 238 CW 169

[SummerEssence 130]

22 minutes ago, Sosewsue61 said:

Did you have sleep study done? sleep apnea is a comorbidity. Does your insurance NOT cover bariatrics at all, or only with comorbidities? Or a certain bmi? Many say over 40 bmi w no comorbidities or above 35 with comorbidities.

At any rate, you could always go to Mexico for cheaper surgery. This surgery with its physical restriction is a great tool, you still have to work at it, but keeping the weight off will be much easier

No I haven’t had my first appointment yet. I don’t think I have any comorbidities issues. Also, I’d rather do the surgery here, but thanks.

Edited July 17, 2018 by SummerEssence

[SummerEssence 130]

1 minute ago, Tealael said:

Try anyway to see if your insurance will cover something, even as a revisions from balloon to which ever procedure you are going with. Check for hernias, GERD, everything EVERYTHING...

VSG2017 HW 249 SW 238 CW 169

I’m not sure what you mean when you say revision from the balloon? There’s no revision needed as I stated I lost 17.20lbs however, it wasn’t effective as I’d liked. Thanks for your feedback!

1 minute ago, Tealael said:

Try anyway to see if your insurance will cover something, even as a revisions from balloon to which ever procedure you are going with. Check for hernias, GERD, everything EVERYTHING...

VSG2017 HW 249 SW 238 CW 169

[GreenTealael 25,439]

Perhaps its a way the doctor could work out the medical necessity of the surgery with your insurance. Im no expert when comes to insurance but they tend to need reasons and that *could* be one maybe, because people have to have revisions from lapbands to other surgeries too, maybe the balloon has some failure statistics they are privileged to that we are not.

VSG2017 HW 249 SW 238 CW 169

[GreenTealael 25,439]

Perhaps its a way the doctor could work out the medical necessity of the surgery with your insurance. Im no expert when comes to insurance but they tend to need reasons and that *could* be one maybe, because people have to have revisions from lapbands to other surgeries too, maybe the balloon has some failure statistics they are privileged to that we are not.

VSG2017 HW 249 SW 238 CW 169

[SummerEssence 130]

5 minutes ago, Tealael said:

Perhaps its a way the doctor could work out the medical necessity of the surgery with your insurance. Im no expert when comes to insurance but they tend to need reasons and that *could* be one maybe, because people have to have revisions from lapbands to other surgeries too, maybe the balloon has some failure statistics they are privileged to that we are not.

VSG2017 HW 249 SW 238 CW 169

Thanks