Frustrated -- am I crazy?

I have been all set to have my surgery on the 8th - tomorrow is my pre-op! I have been nervous and excited. Then...I find out that starting in January, my employer will start covering WLS. Great, right? I mean, it would cost me a ton of money to self-pay for the VSG. Cigna will cover the band, RNY, and DS. They specifically say they will not cover the VSG. They require a 6 month Dr. supervised diet. UHC does not know which proceedures they will or won't cover. I have spoken with UHC, the care coordinator, and SBHP. They said they should have more info by open enrollment, which is October 10th. Which, obviously, is a little late for me! However, they do not require a 6 month diet. I had to struggle to get my time off for surgery next week. My mom is scheduled to come down and help me. I have been mentally preparing for it... This weekend, I decided that if there was a good probability that Cigna or UHC would cover the VSG, I would wait. Unfortunately, it does not seem it will be that clear. Part of me says to wait, because if there is a chance it could be covered, it would save me tons of money. The other part says if I wait, there is a good chance that neither will cover the VSG and I will then have to wait until April (at the earliest) to have surgery, and still have to self-pay. Uurrrrgggghhhh!!!! I know it sounds dumb, but this was a whole lot easier when I knew it would not be covered! I know I will not get the band or RNY. I do not really want the malabsorption of the DS, but it is the only one I would even consider outside of the VSG. I do not know what to do! I have to make up my mind quickly, though. Ugh! I know for some it would be a no-brainer -- just wait and see if it is covered. I just want to get started on this journey...if I knew for sure it would be covered, I would definitely wait. Some will say it is only 6 months, either way -- but I could lose a lot of weight in 6 months! How much longer do I have to wait to be healthy? Any advice? Kimberly

Hi Kimberley,

There really is no easy decision here and only one you yourself can make. 

I am also selfpay here we don't have health insurance as such like you do in the States but I am unsure how I would feel about waiting either as its the start of a new life.

I'm not much help at all as I'm the type of person that when I have made up my mind to do it I want it done now! 

Good Luck.

I had something similar happen to me.  I was actually waiting for my insurance go into effect that I knew would cover it.  During that wait, I did my 6 months of "supervised weight related doctor visits". When my insurance went into effect, I had gone through all my "requirements" and was ready to submit to insurance right when my coverage went into effect.  Everything went smoothly, but I remember being worried that something was not going to go right. 

Is there a website or an 800 number that you can call to check on requirements that need to be met for WLS?  Print out or write down that list, then start going through the requirements and start checking them off.  At that point I had already selceted my surgeon and my PCP was helping me too.

As far as the type of surgery, you should be able to get the DS approved as a "staged procedure".  Complete stage 1 (the sleeve), then put stage 2 (the switch), on permenant hold.

Good luck and keep us posted.

Brooke

 Unfortunately, there have to be 'reasons' why the surgery cannot be performed in one surgery, or they will not pay. My BMI is high enough to qualify for the DS, but not high enough to give my Dr. a reason not to do it all at once (except that he does not do the DS anymore).

Kimberly

 Me, too! Thanks, neenz! :)

Can your surgeon appeal the insurance company for you?  Mine did, and after his efforts the insurance company is not  paying for all of it but something is better than nothing. 
I think if I were in your shoes I would stick to my plan regardless.  You went through a lot of medical technicalities to get to pre-op and all of those precedures usually have a six month expiration date, then you would have to start them all over again.  I wouldn't wait for open enrollment, what if you wait and they still dont cover it.  OMG- I would be so upset.
Ultimately, the decision is yours to make and regardless of what you decide, we all will be here to support you!
Good luck

 Good points, thanks! I did find out that both UHC and Cigna are out-of-network (or rather the Dr. is out of network!). I don't know if he could appeal or not, because of that -- plus, my Dr. does not do the DS.

Kimberly

I don't know how much you are paying, Kimberly, but you might want to ask yourself whether getting it done now - and having the uncertainty and the waiting over with, as well as the surgery of your choice NOW, rather than later -  is worth the price to you. I could have had an RNY for free through the national health system here. I would have probably had to wait for about a year. For me - and even though I had to borrow the money - it was absolutely worth it to get the VSG, which is what I wanted, and to get it on my schedule. I have never regretted it for one moment.

If, on the other hand, you were to find out later that insurance would have covered the VSG, would you be so unhappy with having made the decision to go ahead with it that you would regret it terribly, be angry, etc? And you won't be nearly so unhappy and angry if it turns out that it is not covered and you still have to be a self-pay, but have "lost" six months? If you answer yes to both questions, then it might be worth it to you to wait.

Once you get to this point, six months IS a long time, and it can also be expensive, since the insurance companies do not always cover the doctor/nutritionist visits etc., that they require to meet their ridiculous, medically unfounded requirement for a six-month "medically supervised weight loss program."

Whatever you decide, I would only encourage you to commit wholeheartedly to the decision you make and decide IN ADVANCE that you are not going to regret or be angry about it if it turns out that it might have been better (on whatever grounds) to have decided otherwise. No point in letting your decision eat at you once it is made. Good luck!

 Ros-mari --

I decided (before) that it was worth paying for the VSG, and my feelings have not changed! The info I am getting seems to indicate I am not likely to be covered for the VSG, and although I would be disappointed to find that it would be covered next year, I don't think I would be disappointed to have had the surgery already (even if I paid for it myself). :)

So far, I think I am just going to go forward with my original plan. :)

Thanks!

Kimberly

Kim, that would be my choice as well.