on the fence insurance or on my own..help!!

[felkatz 3]

I don't know what to do. Should I just try to see if insurance will pay? I have a BMI of 45.. no co mordilities. I want to get this done before aug 14 (before school starts up again). Ugh! i'm so confused. I tried to get this done last summer.. but got scared or nervous and stopped. I restarted in January this year to do my monthly weigh in with doc.

Now i'm like, doc only told me once about a diet.. she just kept track of my weight.. She asked what i've been doing and thats it. I missed one month of seeing doctor. right now i'm like should i just pay because i know i'll get denied.. or should i wait? My BF is like look.. if your gonna do just do it! make up your mind! I love ya but decide. Don't be going around it.

I'm so confused right now. Because i'm seeing other people who are in the same insurance as me getting approved in a week or few days.

HELP!!!

[RestlessMonkey 7]

If you've got 15K to waste, I could use it. Why on earth would you NOT use insurance if you could? I don't quite understand....

[felkatz 3]

because.. i've already put it off a year ago.. If i dont do it now i'll never get it done. I don't think i'll get approved because i don't think my primary doctor actually did my 6 months in.. I wasn't really informed of what i needed. My advocate was changed and never heard from her. I missed one month of weigh in. I have no co-morbidilities. I'm blood pressure is that of a teen ager. no cholesterol, no diabeties. i'm healthy but just obese! why would insurance pay 15000 for someone who doesn't even go to the doctor.. less expensive to just say no?

i'm confused! ugh!

[Evie71609 0]

My insurance won't pay because i work for a company with less that 50 employees- the same insurance pays for the procedure for larger companies (this is perfectly legal in Maryland) so I am forced to pay out of pocket. Locally it is $17k but I decided to check out of state (not country) I am flying to Detroit, MI on July 15th and having surgery on the 16th- per the doctor I can fly back home the next day. I am choosing to stay local for another 2 days and fly home on Sunday- in total with airfare, hotel (they supply room for 2 nights) and surgery I will pay $11k (this includes my mom's airfare) - you can deduct on your taxes. So if you are ready then jump in feet first.... good luck!

[Erin 6-9-2009 0]

My opinion is if you want this bad enough and you've waited and waited it's time to do it!!

I am a self pay. My insurance wouldn't cover it.

My mom tried to fight insurance. Her BMI was over 40 and she had comorbidities. Diabetes (with a lot of insulin via pump) and sleep apnea. They fought for a long time and they were never going to approve it. It's a very hard battle to win these days. She ended up self paying and is now down 100 pounds, off all medications (completely diet controlled diabetes), no apnea and at goal. This all since April 1, 2008.

I say go for it!! You seem ready!

[NurseMelly 0]

I still don't understand why you wouldn't submit to insurance and see if they deny you first.

I had a lower BMI than you, am younger, no comorbidities and I was approved a week and a half after submitting the paperwork.

Do your part with the paperwork and see what insurance says then go from there.

[llminer 0]

I think you should at least try and see if your insurance would cover it. Perhaps your doctor will be able to say something in the records about possible health issues you'll be facing down the road if you don't lose weight. Insurance companies know that they are likely to pay more down the road if you keep the weight on, you will eventually have health issues. If they still say no, then go ahead and pay for it if that's what you want to do.

[felkatz 3]

i'm ready.. i can't wait another moment.. i held off already a year.. i missed one month of my 6 month visit... and i don't think the doctor documented correctly because i didn't have the correct info until after the 5 month. Soo... bah.. i'm ready.. i'm going tomorrow for the shakes..etc.. i don't wan tto wait and hold off another year then gain more.. blah! i'm ready!!!!

[llminer 0]

Determination.......I like it. Good luck to you.

[MissBS 3]

I had insurance that would pay for my surgery (??) but I chose to pay for it myself. I am not a good hoop jumper and I didn't want to play their way. It would have taken me a long time to get to the point where they would make that final decision - I didn't want to wait. I paid $12,900 for my surgery, which includes 2 years of "free" follow up visits and fills. It was 23 days from the time I had my initial consultation to the date my surgery was scheduled. I did what I needed to do and I haven't regretted it for one second. Now, I must say..... I may not be the best person to respond to this question - I have issues with insurance companies.... but that is a whole other story. You need to decide what is best for you. Good luck to you in making this decision and with your journey ahead. I love my band!!! Becky

[thebandedgirl 0]

My insurance didn't cover the procedure. The company I work for is switching insurance companies soon, and I guess I could have waited until the switch happened to see if the new insurance would have covered it. I didn't want to wait two or more months (it was supposed to switch in July, now they're saying August...) until the insurance changed and then wait another 6+ months while I jumped through the hoops of a supervised diet, etc.

Having said that, if my current insurance had covered the band, I would have tried for it. I'm going to be in more debt than I was for a long time. Worth it? I think so. But it's still a financial burden.

[FailureIsntAnOption 0]

I went to Mexicali, Mexico and self paid $7,000. No regrets here. I had great care in Mexico.

[Who'sThere 331]

I would get my records from my PCP and take them to the surgeon. The coordinator in the office should be able to tell you what your insurance would require. If they think you have a chance, I'd submit it. The worst that can happen is they can deny you and then you can self-pay. I'd at least try it though. My surgery was approved within minutes of being submitted. My BMI is over 40 (as you can see in my signature) and I had no comorbidities. However, I did have my 6 mo. weigh-ins and a letter from my PCP. Anyway...give it a shot! You could spend that money on new clothes when you get to your new size!!!

[texas mommy 0]

I know your frustration...I did the same thing: 6 months of pcp supervision and she had to submit documented notes and then I had a psych. eval and 2 other evals and ARHGGHHGHHHHHH. What a pain in the tookas! Now, even so...the surgery will cost me only 20% of what it would have self pay. Was it worth it....I don't know. Really, sanity is a precious commodity. If the thought of doing it that way was stressing you then, maybe so...Like MissBS said, insurance is one way to play it. I am hearing that you are a teacher in TX which means that you have teh same crap insurance as me...I feel for ya.

On the other hand, these 'hoops' I had to jump through were beneficial. 6 months of pondering, making genuine attempts at healthy lifestyle on my own, more pondering, getting evaluated....this all took lots of work, patience and perseverance on my part. I learned much about myself and how I work. Also, I earned this F***ing BAND! By the end of this circus act my ins. company had me go through...my feelings about getting this thing were more evolved than if i had 'run out' to get it on a whim.

But again, either way that cookie crumbles...you can be successful. If you want something bad enough, you'll do what needs to be done...whether that is jump through someone else's hoops or put yourself in debt. I just happen to be at a place in my life where I avoid financial debt like the plague. So, jumping through hoops for this evil insurance company was more palatable for me...

You make your choice and go....listen to your BF! :-)