Getting discouraged, no clue what I should do next, any advice welcomed

 I started this process in October of last year.  Finally, I was ready to go full forward and commit.  I have gotten through the whole process up to scheduling the surgery and now this.   

First of all I was going for the RNY.  LapBand just wasn't something I want, whether it be unrealistic or not, I am not comfortable with a foreign object like that in my body.   Then I find out that because of my narcolepsy/cataplexy medication I cannot do the RNY.   So my surgeon, who has been wonderful (office staff included), told me about the sleeve.  YES!!!!! finally an option that works for me.  I can still take my medication and still get the surgery done! 

NOW THE PART THAT HAS JUST TORN me down completely:

According to Dr. Scott's office again today Medicare (nor MO medicaid)  does NOT cover the  Sleeve under any cir****tances, and my self-pay costs would be $25,000.  AHHHHh no.  Can't do that under any cir****tances unless missouri lottery come through (which I hardly ever play so that isn't an option).   SOOOOOO NOW what?????  

I really do not feel comfortable with the LapBand idea, so what DO I DO NOW??   I guess I can wait and hope that the sleeve soon gets covered by Original Medicare.  But probably not.  I guess my next choice is either ,get the LapBand (even though I am really against the idea), or maybe find a Medicare Advantage/Supplement  Plan (I am still not sure which is which)  that does and switch at the end of the year then begin the process over again.

This is SOOOOO discouraging.   I was finally completely ready for this mentally and physically and now this.   

 

My insurance also didn't cover the sleeve at first. It took a year but finally they approved it (a year later) I'd say pick the surgery that you know is right. I understand your frustration. Keep your head up and your eye on the prize. Good Luck 

My doctor in The Dallas area does the sleeve with hospital stay for a cash price of $9995....My daughter and I have both had the sleeve done with revision from lap band...no problems at all. His name is Frank Veninga and he uses Forest Park Medical Center..we were very pleased with him...don't know how far that would be for you to come.

If your BMI is over 50, you can get the DS. The sleeve is the first stage of the ds on really large patients who may not do well if the dr did the straight sleeve. These surgeries are done months apart but the sleeve became popular because people were loosing so much weight with the sleeve alone. Talk to your dr and see what he says

You can have it done in Mexico, I know is cheaper.  A lot of the OH members have had the surgery done in Mexico.  They can give you all the details.....

 Beauty is right. So is Sunny. Mine was done in Mexico and I financed it!!!!!!!!! In house financing!!!! check out www.beliteweight.com

Good luck and chin up!!!
Jen

My physician is in Federal Way, Washington. I was self pay $15,000.

Have you appealed it to medicare?  With documented proof that due to medical conditions the RNY would not be a viable option?

Squeeky wheels get the grease.  Advocate for yourself - sometimes docs give up too fast because they aren't making money making calls and writting letters....it'd up to us to advocate for ourselves....

Here's what you do. You write a long heartfelt letter appealing their decision or their policy. State why you need the surgery (obesity, diabeties) put in statisitics about obesity and the vertical sleeve. Put in reasons you need the sleeve VS the RNY/Lap band. Put in labband's faluire rate. REally pull at the heartstrings. Include a photo. Tell your insurance company why they want you to have the VSG, how they will be spending less. I had both my parents do this and they won their appeals althought it wasn't for weightloss it was actually for addiction treatment. I believe since they already cover weightloss surgery in some forms they will be inclined to make an exception. If you want to see my appeal letter message me and I"ll send it to you. I ended up going to Dr Aceves in Mexico because my insurance didn't cover wls in any form. I had a great experience there if you decide to go that route!

 I would love a copy of the appeal letter.  Anything is greatly appreciated at this point.