No Sleeve for me, need two knees - not happy- long

Hi - had a band in 2004 - had it removed in 2007 - insurance wouldn't cover revision - tried going on my own - gained weight back (only lost 30 lbs with band) and recently have been inquiring about VSG.  WLS is excluded from my insurance coverage by my husband's employer - I called anyway and was told - that chance of any successful appeal is zero.  All of my physicians - orthopedist (need both knees replaced), nephrologist (only have one kidney due to cancer), pulmonologist (have sleep apnea), endocrinologist (have diabetes), cardiologist (high BP), urologist (frequent bladder infections), gynecologist (had hyst due to pre cancer condition), gastroenterologist (have reflux), and any other dr I have been to - thinks WLS would be most beneficial for me.  My BMI is 48 and I am 60 yo.  So I checked around - I live in NE Ohio - the price range for the sleeve is 18600-25000.  Can't go to Mexico (long story). I haven't worked in 10 years,  Husband is in early stages of dementia and has diabetes - so I am his caretaker - needless to say I don't have the cash to pay or access to borrow it.  So I am extremely disappointed!!!!!!
I have almost no mobility - hard to grocery shop,or  go to grandchildren's events, take care of teh house and my husband and I am in a lot of pain.  I am so nervous about having the knees replaced that I keep putting it off - I so fear the pain and recovery.  I know my weight will make it extremely difficult and I wonder if I can do it.  I just know losing weight would help all of my health issues.
So if you have stayed through all this -
1) Anyone have knees replacements while obese and how was your recovery?
2)  Any other suggestions on how to improve my situation.

Bariatric surgeon's office told me to wait til Medicare covers me - that's 5 years - I think I will be dead by then.

You really have quite a bit on your plate!  And what a disapointment to be told you need to wait five years for insurance coverage for surgery.  I don't have any easy answers for you, but I do wonder if you have looked into home care or respite care for your husband?  If available, it might fill the void while you recover from knee surgery.

Wow...this is so sad...exclusions are tuff nuts to crack...Im wondering if there IS such an exclusion for that rep to say..successful appeal is zero...how can you appeal sumthin that's excluded?  Sounds kinda fishy huh!

Do you have the hard copy of your policy...or a link to your ONLINE policy...

I'd head straight over to the OH Insurance Forum and post there...provide with an online link, post the NAME of your insurance and the STATE...let them guys take a gander.
http://www.obesityhelp.com/forums/insurance/

Some info on my VSG INSURANCE WOES...towards the bottom...YOU MEET THE CRITERIA!
http://www.obesityhelp.com/member/carmelita/blog/tag/vsg+ins urance+woes/
Just gotta read/get ahold of that policy! 
Them customer services reps....uggh...you can call em 10 different times and get 10 different answers...till ya get one that gives a ****  Next time you call em...ASK TO SPEAK to a SUPERVISOR!!  GET NAMES..and if that supervisor is a good one...only deal directly with him/her. 

Also if push comes to shove...OPEN ENROLLMENT is just around the corner...can't hubby get into a policy that HAS a WLS contingency? IF indeed VSG is EXCLUDED... Or is he stuck w/ this one.

I'd contact your state's dept of managed health care, and the state insurance commission too...I couldn't take no sittin down...its the squeaky wheel deal...GO FOR IT OHIO!

just hang in there...easy for me to say eh!

The booklet that they give us every year - does state that WLS is excluded.  My husband is retired - so we don't have a choice on the insurance and since he is on Medicare - they provide me the option for the insurance with BC BS of Illinois and really it is a good policy for most everything else.  I am lucky they provide the group option for me since so many companies are dropping insurance for retirees families and with all my problems - I need it and could never afford private insurance.

But I am going to investigate your other suggestions - thanks.

Hmmm....I don't know...since you don't have an online link for anyone to eval, but DO have the hard copy..can you POST the BARIATRIC POLICY namely the EXCLUSION sect....VER BATIM at the Insurance Forum. Sometimes...what we think it means...ain't what it REALLY means...ykwim

ex. Peeps here get denied at pre-authorization as VSG is "USUALLY reserved for peeps w/ BMI over 50". A standard insurance speed bump to get denied at pre-auth...They get freaked out..gain weight, put weights in their clothes at weigh in...but they NEVER EVER pay attention to the word USUALLY. That's NOT NIH policy!! The FEDS!! ALL INSURANCE COs w/ WLS plans must abide by NIH CRITERIA! BMI over 40 no comorbidities required..35-39.9 1 major comorbid or 2 other. THAT's THE CRITERIA!! Just a bunch of insurance hoops we gotta get past..our health care system dontcha just love it! lol

Also since BCBS IL is FANTASTIC is every other aspect...of your health care so far...MAKES ME HIGHLY SUSPECT they have NOTHIN as far as WLS, even medically supervised diets as prevention. Most SELF FUNDED ins. comps...have MANY limitations as far as what their members are allowed...and sounds like you've had NO PROBLEMS there. I just don't know!

On my Insurance Woes link..there is also a link to Obesity Law maybe email them tell em whats going on... and see if they would advise. They may be willin to take ya on!! There are ways of pulling HR into coverin, making exceptions for LIFE SAVING,ENHANCING WLS procedures. vs continuing to cost em..more n more medical expenses. I DON'T know a thing about petitioning HR tho. It ain't BCBS its HR you gotta pull in...and there are ways! Obesity Law has some great info on their site, Ive also read of em goin the distance and gettin shot down on some exclusions... but its worth a try right.

Ya got alot of work ahead of ya....either way.

I was on the diabetic diet for 5 months pre-surg...took all these classes, went to seminars on diabetes...lost 15 or so pounds didn't do a dang thing for my diabetes tho ...but I gave it a shot!

Make up yer mind today..to start thinkin HEALTHIER while yer finding yer answers..
Reducin your calories, avoidin ^cal crap foods...uppin yer exercise...even liftin cans of beans get movin upper body (I exercise w/ old milk jugs filled with water..lol!!).....so yer increasin yer burn. while yer watchin TV...consistent..in one week guaranteed you've lost a pound or two! Then tackle the next week...develop a plan..and put it into action...cuz it don't happen by osmosis pre or post op...dang it ,-)

Keep at it OHIO!! Much luck to ya.

I have a dear friend that had knee replacement surgery a couple of years ago. He had an excellent surgeon, but he was and still is obese. He did far too much, too soon and really did some damage to his legs during the healing process. What he learned from this experience was that he should have listened to his ortho surgeon. He didn't lose the weight he was supposed to after surgery and against the surgeon's continued advice had both knees done at once and then DIDN'T FOLLOW RECOVERY INSTRUCTIONS for having both knees done at once. Whatever you do and decide, figure out a way to take care of yourself and give yourself time to heal.
I'm so sorry that you can't get sleeved. I know how desperately I wanted approval and when I got it, it changed how I looked at my life.
Good luck, dear. My best wishes are with you.
Kairk

That is terrible. I take it you don't have any kids or close relatives who can give you a hand? The respite idea would be a great help. Funny thing is your knee's may improve with the weight loss too. At least you could probably wait longer for the sugery, so you can recover quicker when you are lighter. Whenever we are in a desperate need money, we resort to selling things. Like a camera, my husbands drum set, anything of some value, to help get the funds. Do you have any savings, investments you may cash in on, or thought about selling the house? It is a drastic move, but maybe neccessary if your life is on the line. Where there is a will, there's a way...Don't give up. Consider self pay and don't wait the 5 years. 

No family close that can help.  My husband is not disabled - just has trouble remembering to take his insulin and meds - so always a chance for hypoglycemia or diabetes complications.  We sold our house at a loss 3 years ago - and we now rent.  Not much I could sell at this point that would make a dent in a $20k surgery cost.  I appreciate your reply.  And I'm not giving up.

 Have you tried looking into a line of credit, or a medical loan? I too thought Mexico was out of the question, until I researched it and have decided that is the best option for me. Dr. Aceves is offering the sleeve for $8,750. Huge saving from $20k, and he is the real deal. Never heard one negative comment about him, the hospital or the surgery. Worth looking in to. 

I wouldn't rule out respite care just because your husband is not physically disabled.  If he doesn't remember to take meds on his own, then he needs a caregiver, and I think most insurance companies cover at least some home health services.