Brand New - Feel so in the Dark

Hi all, I was wondering if someone could just tell clear up a few things for me and help me as I am at the very, very beginning of this journey and have been told so many different things.  I was considering the Gastric Sleeve as I have seen amazing results with minimal side effects.  However, my BMI is 33 and I have been told that this won't be covered under insurance.  Is this true in all cases, does anyone know and if it is not, does anyone know general out-of-pocket cost?  I am also curious about recovery time in terms of being able to be out of bed, walking and then eventually driving?   What about Pre-OP, any special considerations?  Thanks.  I am at the very beginning of my journey taking the first step.  I appreciate any advice or help anyone can give me.

Most insurance will not cover WLS if your BMI is under 35.  Not the sleeve or any other surgery.   check with your insurance company to find out what they cover, though.

You may be able to find a surgeon to do WLS even if your BMI is under 35 if you also have weight-related health problems like diabetes or sleep apnea, if you pay out of pocket.  If you go out of the country, that might cost $10,000.  If you have WLS in the US, I would expect it to be more like $30,000, probably.

My BMI is 34 BUT I do have high blood pressure and my cholesterol is a bit high.  I don't have sleep apnea (though I do snore very loudly so my family tells me ).

I called the company who deals with my insurance company (Accolade is a service we have where we can ask questions to instead of calling BC/BS directly...we speak to nurses or case workers) and they looked at my policy to make sure my procedure would be covered (I'm having the sleeve on 2-19-14).  And it's fully covered.

So just because you have a BMI under 35 doesn't mean that it won't be covered.  Just call and ask.  Good luck!

I'm not gonna be too helpful probably,  but I can send you in some right directions to  find your specific answers. (I had a mutated RnY,  not a sleeve, but there are lot of sleeve folks here on OH.

First, about the cost and the coverage - that's on you to find out.  Not trying to be rude, just that we don't know what insurance you have and even if we did we wouldn't know about your specific policy.  Call the 800 number on the back of your card.

As far as your BMI, again, that's somewhat of an insurance question because most insurances don't look only at BMI, they also will consider your "co-morbidities", or in other words, your general health.  Your best bet is to sign up with a WLS doc in your area and go in.  They'll actually call your insurance for you in most cases to see if you're authorized.  If you're not authorized, you may have to pay for this initial visit. May.  Not many people I know have had to.

Then to your  more specific questions about recovery times, etc as well as pre-op instructions.  If you're set on the sleeve, you can go hang out on the sleeve board here on OH at: http://www.obesityhelp.com/forums/vsg/     This is where the sleeve folks hang out.

And one last thing.  I'd encourage you to look at ALL surgery types before you commit to any one or another.  There are the Duodenal Switch, the Vertical Sleeve Gastrectomy and the Roux en Y (or RnY),  I will also mention the Lap Band simply to avoid conflict.  Some folks have been successfully banded - but I don't know of any personally.

Anywho.  Welcome.  Do your research before you make a commitment because although for me and countless others this has been a God-send, I don't hear too many people who are happy about having to have a second surgery.  You have to do what's right for you - you know your body. 

Enjoy the journey=)

edited because I may be thinner, but I still apparently can't spell

I think I've probably heard this before, but would you tell me again how your RNY is 'mutated'?

P.S.---I really enjoy your posts.

Why thank you Ms. Batt.  I enjoy reading your posts as well.

I suffered from severe, scarring but non-healing ulcers.  All through out my stomach.  At the end, the stomach tissue was so bad and the flare ups so constant that my pyloric channel regularly was blocked by either scar tissue or inflammation.   They dilated it several times but the problem was recurring and I  became close friends with the dreaded ENG tube/container/etc.  It was awful.

Eventually my doc decided to remove a lot of my stomach.  I was severely overweight at 347lbs and asked if he knew of anyone who could put a Lap Band on while they were in there.  THANKFULLY I went to a great surgeon who is also a decent guy and he talked me out of that particular option.  The answer for me turned out to be a Near-Total Gastrectomy as well as cutting up and removing some intestine.  I could not have ever kept my pyloric valve/channel - AND I had considerable iron malabsorption issues even preop so they weren't thrilled at removing a lot of upper intestine either.

So I'm kind of a mutant.  They cut away so much of my stomach that even though I don't have a sleeve or DS, I don't have to deal with a remnant stomach or the hunger producing hormone ghrelin. But I have more intestine left than most RnY's.

It's been successful, although I've had some rebound weight I've struggled with I've been able to re-lose it fairly easily when I put my mind to it.  I'm happy.  Except for still having violent dumping episodes and some serious RH.  Most of those were my own "fault" - as in, I knew I had no business eating the stuff I ate when they happened.  I had hoped the dumping would go away as I had heard rumors that it would but no luck.  But I'll take it.  I'm alive.  I have medical problems but I can live with them and at 50 years old I have to expect them, especially considering all this body has been through.  (I've had lots of other medical stuff that was never weight related).

So there's the scoop.  I just don't want to really claim a full RnY because I feel I've gotten a bump from not having the ghrelin producing stomach.  But then I've got more intestine than most so maybe it evens out.  Anyway, it works for me=)

Glad to see you're still posting.  I only come on once in awhile anymore and a lot of folks aren't here.

Thanks so much, all you said makes sense so I appreciate everything.  Yes, true, it seems much has to be done on an individual basis in terms of insurance.  I am attending my hospitals large and very successful seminar at their Bariatrics Dept. on Tues.  This helps to explain all the different procedures indepthly.  It has an excellent reputation so I feel comfortable.  Thanks for the beginning steps of help by helping to answer my questions :-)

Read, read, read, and then read some more here.

First, check with your insurance company to confirm coverage, and find out what requirements they have.  

Read the different surgery forums here.  When I first came here, I was planning on having RNY, but now I'm leaning toward the Sleeve because of what I've learned here.  Surgeons at my hospital don't recommend the band - you'll learn more from reading here.   Each type of surgery has pros and cons -- you have to decide what's best for you based on your own conditions.   You can also use the search feature if you want specific information on a specific topic.

Recovery time varies from person to person.  Read the blogs and posts - they're a wealth of information.

Welcome to the boards!

I wanted the sleeve, but I had severe GERD and still have Barrett's esophagus, so the sleeve was not a good option for me. So I have my RNY, with the trade off of not being able to take NSAIDs. All of the surgeries have cost/benefits.

At the time, my insurance would only cover a BMI of 40 or over, 35-40 with at least two co-morbidities. But every policy is different. My BMI the day of surgery was 35, and I had 3 co-morbidities, all of which have been handled which I am more than grateful for.

Costs depend on where the surgery is done. A lot of people go to Mexico for less expensive surgery, but that takes researching your options carefully. The most important thing for me was making sure I had a top notch surgeon. Info sessions and support groups were helpful in finding mine- I went to several.

Re: pre-op and post-op needs, I would suggest doing your basic research first, and then ask those questions.