$18K Out of Pocket or wait a year for full insurance coverage or just diet?

[SoCalGuy6622 1]

Hi all, so I’m having a bit of a dilemma and I was just curious to know what others would do in my position.

My wife and I currently have Kaiser insurance here in California. Based on their program, it would be 10 classes (2.5 months) and then I would have to wait to get on the books for surgery, the person I spoke to said it could be up to a year wait. BUT, I have zero copay and the surgery would essentially be free.

On the other hand, there’s the possibility of taking out a Care Credit loan at for $18.5k 0% APR and I could get the sleeve at Blossom Bariatrics by next month if I wanted to.

I know it seems like a no brainer to just be patient and wait. That is the smarter financial decision. We do have to put a new roof on our house (or we could wait until next year) and we are definitely worried that if I take out an 18k loan… that our financing of our roof would come with a stupid APR and would ding our credit. We are in our 30s… no kids… live comfortably financially but not well off-which is why the 18k seems a little crazy, although the monthly payments are totally doable for me.

On the other hand, I’m almost prediabetic, high cholesterol, feel like my eating habits are spiraling each day. I am genuinely upset that I feel like I’m turning to surgery as a last resort and tool. I’ve tried every diet, every app, every diet pill from my Doctor, I have spent thousands at this point for personal trainers, my mind is consumed with the state my body is in, I feel exhausted, not healthy and I also feel like it’s holding me back from progressing in my life/career. My confidence level, well, it doesn’t even exist at this point. I feel defeated and the amount of energy I use thinking about losing weight/getting healthy is maddening and exhausting.

I feel as though one can’t put a price tag on health. I feel like the gross amount of money I spend on eating out nearly every day, buying food, paying for this diet or that gym equipment… would also be eliminated to an extent if I have surgery. So, I kind of feel like even spending 18k… I would SAVE in the long run. I have a ton of goals I’d love to accomplish over this next year… and I feel like the thing holding my back is my health/confidence/lack of energy.

My wife is wonderful and we have long, real discussions about all of it. She’s kind of the financial whiz of our life and we are both wondering what the best option is. Spend the money… get my health on track ASAP… save money in the long run because I’m not eating out multiple times a day or buying whatever I think will help me finally get on track. (She also feels like this would help her as my eating habits are starting to wear off on her she says)…OR Wait a year stuck in this loop, possibly gaining more. But I'll pay nothing.

There’s so much that can happen in a year… but I don’t want to remain stagnant, spiraling for a year… I want to jump start it and move forward and get this over with and move on. But I can’t figure out what the best choice is. Further, I'm so afraid that even using the sleeve as a helpful tool, that'll I'll just fail at that as well.

Thanks for reading my vent. Would love to hear some of your thoughts.

[Sleeve_Me_Alone 656]

There is no right or wrong answer, only you and your wife can decide what is right for you. BUT, I consulted 3 times and backed out every single time, before I finally decided to go the self-pay route and had surgery. All the appointments, the doctor supervised diet, the insurance requirements, etc etc etc. wore me down and stressed me out, so I always bailed. Opting to go the self-pay route got me a surgery date immediately and that was exactly the push I needed to follow through. My only regret is not having done it sooner.

Is there any chance you could seek out of network reimbursement? That way, you can get surgery sooner and potentially cut down on the out of pocket cost?

[kcuster83 1,504]

Hmm, the decision is solely yours and your wife's.

I am also in my 30's with no kids and we are financially very comfortable but I feel like the reason why is because we don't spend 18K when we don't NEED to. Get my point?

The point of the insurance requirements are to get you focused, prepared and starting the process of your new life long requirements.

If you start to make the changes that will be required after surgery, you will not spiral while you wait. You will however get more prepared and ready for your new life.

I had a 6 month process that was "fast tracked" and surgery at 4 months. With that being said, I learned a lot about what to expect. I already knew how to eat healthy and how to read nutrition labels etc. (Which both were part of my classes) But what I found most knowledgeable was what to expect after surgery. I have heard stories from people I know who went through WLS but I found a lot of their information was false or they just didn't understand what they were actually being told. Two other people I know had the exact same surgeon at the same bariatric center and have the same support team through the center. (Including the same Dietician) yet both of them had different understanding of things. The best thing I could have done was take those classes myself and get the answers directly from the providers themselves.

It is like in Elementary school when we all sat in a circle and the teacher whispered a statement in the first kids ear and by the time it was whispered 13 times, at the end it was completely different.

I also have lost and gained over 100 lbs 4 (i think) times before having surgery. Worked with a trainer, bought exercise equipment...etc. I still lost 40 lbs in the pre-op process just by making VERY TINY changes that they suggested starting with.

ok ok, I said a lot and probably boring you now.

My opinion from a financial standpoint and from a learning/preparation standpoint would be to go through insurance.

But really, you just have to make this decision yourself.

[liveaboard15 1,293]

I would wait. taking out a loan for almost $20K takes a long time to pay back... about 5-7 years. idk what the terms of that 0%APR is but i do remember that if you end up missing payments or paying late that it reverts back to the extremely high APR that care credit charges which is close to 30%. and with a loan that big that would take decades to pay off. I paid Cash for my surgery and it was around $18-20K. Only because my insurance specifically excludes it. otherwise i would have waited. Rather have $20K in my bank account if i only have to wait a year.

[catwoman7 11,210]

this is only indirectly related, but I had to change insurance companies to get my WLS covered. I decided in May or June of 2014 that I wanted it done, but my new insurance wouldn't kick in until January 2015. So I checked to see if I could at least do the six-month supervised diet during those interim months (my new insurance required this supervised diet. Not all require that, but it seems like most do), and if they would accept it since I would have done it through my old insurance company, and not them. They said that was fine - they would accept it as fulfilling the requirement even if I had it done elsewhere (of course, it all had to be documented, which it was). So if you decide to wait, you can always see if you can knock out a requirement or two while you wait.

[I♡BypassedMyPhatAss♡ 804]

If I were in this situation, I would wait and go through insurance. Spend the time while you wait fixing any habits that would be counterproductive to life post weight loss surgery. Stop eating fast food and focus on healthier foods so you know what to expect after surgery. Look at the year you spend preparing for surgery as an investment, and how you will be more successful if you're not battling food issues.

Best wishes!

[SuziDavis 546]

3 hours ago, SoCalGuy6622 said:

Hi all, so I’m having a bit of a dilemma and I was just curious to know what others would do in my position.

My wife and I currently have Kaiser insurance here in California. Based on their program, it would be 10 classes (2.5 months) and then I would have to wait to get on the books for surgery, the person I spoke to said it could be up to a year wait. BUT, I have zero copay and the surgery would essentially be free.

On the other hand, there’s the possibility of taking out a Care Credit loan at for $18.5k 0% APR and I could get the sleeve at Blossom Bariatrics by next month if I wanted to.

I know it seems like a no brainer to just be patient and wait. That is the smarter financial decision. We do have to put a new roof on our house (or we could wait until next year) and we are definitely worried that if I take out an 18k loan… that our financing of our roof would come with a stupid APR and would ding our credit. We are in our 30s… no kids… live comfortably financially but not well off-which is why the 18k seems a little crazy, although the monthly payments are totally doable for me.

On the other hand, I’m almost prediabetic, high cholesterol, feel like my eating habits are spiraling each day. I am genuinely upset that I feel like I’m turning to surgery as a last resort and tool. I’ve tried every diet, every app, every diet pill from my Doctor, I have spent thousands at this point for personal trainers, my mind is consumed with the state my body is in, I feel exhausted, not healthy and I also feel like it’s holding me back from progressing in my life/career. My confidence level, well, it doesn’t even exist at this point. I feel defeated and the amount of energy I use thinking about losing weight/getting healthy is maddening and exhausting.

I feel as though one can’t put a price tag on health. I feel like the gross amount of money I spend on eating out nearly every day, buying food, paying for this diet or that gym equipment… would also be eliminated to an extent if I have surgery. So, I kind of feel like even spending 18k… I would SAVE in the long run. I have a ton of goals I’d love to accomplish over this next year… and I feel like the thing holding my back is my health/confidence/lack of energy.

My wife is wonderful and we have long, real discussions about all of it. She’s kind of the financial whiz of our life and we are both wondering what the best option is. Spend the money… get my health on track ASAP… save money in the long run because I’m not eating out multiple times a day or buying whatever I think will help me finally get on track. (She also feels like this would help her as my eating habits are starting to wear off on her she says)…OR Wait a year stuck in this loop, possibly gaining more. But I'll pay nothing.

There’s so much that can happen in a year… but I don’t want to remain stagnant, spiraling for a year… I want to jump start it and move forward and get this over with and move on. But I can’t figure out what the best choice is. Further, I'm so afraid that even using the sleeve as a helpful tool, that'll I'll just fail at that as well.

Thanks for reading my vent. Would love to hear some of your thoughts.

There is not a right answer, but there are also options under $10K in Mexico. There are many many people who go and do it that way and have nothing but good things to say.

[SpartanMaker 767]

I agree with many others here that have said only you can decide what's right for you. I will share some of my thoughts & experiences in the event they will steer you one way or the other.

First of all, I think we all can sympathize with wanting it done NOW. I personally have been waiting 2.5 years to have my surgery and (maybe unrealistically), sincerely believe that my surgery date is when my new life will begin. It's hard to be patient for such a life changing thing.

Even though I could easily have written a check for the cost of the surgery, I never really considered self-pay. Remember that ultimately surgery is just a tool. Even though it can be lifechanging, I know I still have to put in the work to be successful. Unfortunately, too many people end up right back on the diet yoyo. The last thing I want is to go through all this and still fail. For me, getting to this place where I really do feel mentally and physically ready took time.

Perhaps a minor thing for some, but I also wanted local resources in the event I had complications or needed more help down the line.

Something else for you to consider perhaps? A lot of people that lose significant amounts of weight, eventually need plastic surgery to get rid of excess skin (and potentially correct some other issues). While sometimes that can be covered by insurance, most of the time it's not. My point is that you need to make sure you're also financially ready to take on that expense.

[Smanky 747]

I took out top health cover and had to wait a year because my obesity was a pre-existing condition. Yeah, it was a long wait, but it gave me time to really get my head ready for the surgery and life change - this is actually SUPER important. Without the surgery I'd still be morbidly obese and miserable. It was absolutely worth the 12 month wait. The surgery nerves kicked in about nine months in and the last couple of months honestly flew by.

[NovaLuna 710]

I waited 8 months in total from my first initial consultation until my surgery and I wouldn't have changed it. Those 8 months helped put me into healthier eating habits so that it was a LOT easier to adjust to the post-op diet then if I'd just gone and self-paid. I also lost 68 pounds in that time. But, honestly, everyone's case is different. You are the one who knows you best and you are the only one who can make that kind of decision for yourself. Do research, make a pro's and con's list, and then once you've got it all in front of you then just go with your gut.

[Queen ApisM 427]

My wait to surgery was almost 2 years. I was originally talking and planning about in late 2019. I was always going to be self pay b/s it is excluded from my health insurance policy, so I looked at practices and settled on one. Then, coronavirus hit. I also at that point realized the practice I was going to use was not the right one for me, and investigated a new one, doing a new consult virtually during coronavirus (Aug 20). This new practice had a lot more requirements even for self pay and while I was frustrated, in the end it was the best thing that happened. Now, what wasn't good in that time is I gained more weight (I blame it on the weight a lot of us gained during COVID but I just was in a weird place and under a lot of stress at work - quit that job!) but what was good is the program I went with was very intentional about preparing everyone - regardless of whether it was insurance covered or self pay - for what to expect after surgery.

Did it suck waiting? Yes. Do I regret it? Just a little - but mostly because I wish I had found this practice back in Fall 2019! I don't think I would have been as prepared and ready for surgery if I had rushed and gone with the practice I originally was looking at (they are well-known and have a strong reputation where I live, it just wasn't the right vibe). Part of why I feel like the past year has gone so smoothly for me (my surgery was Aug 16, 2021) is the level of mental preparation I had. I also used that time to unpack lots of other issues in therapy, which was helpful.

So all of this is to say... what do you think will give you the most success? Personally, I would try to do it through insurance if I had the chance. It's not just the surgery itself - but what if there are complications? It's rare, but possible, and I had so much stress and worry about how I could bankrupt us if something went wrong. I'd also use the time to try and build some good habits, which is something my program stressed during the education phase: drinking Water, exercising, sleeping well, etc. If you think you have any emotional hang ups about food, it'd also be a great time to work on that, ahead of surgery.

Edited August 12, 2022 by Queen ApisM

[summerseeker 2,114]

We all come at different angles with this issue. I had no choice, I had to pay up. I couldn't wait till the NHS recovered from Covid and I finally found a Doctor who would recommend me for the surgery. I have been asking for 25 years and several had already side tracked me onto yet another diet.

If I had been given your choices then I would wait for the free option. It would be only 4 months longer than I had to wait anyway. The $18,000, I would save towards skin surgery later down the line.

What do you spend on food in a week ? Times it by 52. shakes, Protein Powder and bariatric Vitamins are extra costs that you may need to factor in too.

Keep chatting to us on the forum and read the back pages while you decide. Good luck

[Sunnyway 344]

I lost 70 lbs pre-surgery by cutting out all sugar, flour, white potatoes, rice, and processed food. If dieting has been difficult for you, I encourage you to read about "food addiction". Here are some of the books that helped me.

[AnnaTM 25]

It is a personal decision but I would probably put in the time on the mental preparation that will be necessary for your long term success. Reading books on emotional eating, working exercise into routine and preparing for the overall lifestyle changes.

Sent from my SM-G998U using BariatricPal mobile app

[HashiHope121 78]

If you didn’t have an insurance option I would 100% say go pay for it! A year out now and I only wish I did this sooner. It is worth its weight in GOLD. That being said, I did wait for my surgery (& gained a few LBs) so insurance would cover it, mostly because I was terrified of the bills in the event there was a complication. I think it also depends on your timing in life, if there is something pushing you to get it now, that may be another factor in the pay column- I was moving cross country and couldn’t have waited another year. I think you will be happy in the long run either way & either way you will have this for the rest of your life. Good luck!!