I am so upset. Anyone have experience with Oxford and Dr. Sebastian...

Long story short, ok maybe not, but here goes:

I have had a weight problem my entire life (I'm 53) that I mostly kept under reasonable control until 12 or 13 years ago, when it began to spiral out of control.  

I have done everything humanly possible to rectify this and VSG surgery is the final stop for me.  For instance, two years ago I joined a serious gym (owned by a former Mr. Olympia where serious bodybuilders train) and made financial sacrifices to hire one of their personal trainers.  I was so dedicated to my training schedule that the only two sessions I missed were the day my pet died and the day my wisdom teeth were pulled.  I was doing very well for 10 months until I had a serious tendon injury.  After months of physical therapy and narrowly avoiding surgery, I returned only to find my trainer had left and I was assigned to a real jerk who basically didn't want to train a fat middle age woman.  He came up with excuses and obstacles, and I ended up depressed, defeated and gaining back all the weight I lost plus another 20 pounds.  I literally spent thousands of dollars on this. 

I could go on and on and on an on with every serious effort I have put in to combat this. I put a lot of thought and research into this and decided on VSG surgery.  I was thrilled when I found a group of doctors in Jersey City that do it as I do not drive.  I called in May and made arrangements to go to the June seminar at the Jersey City Medical Center.  While I was on the phone with their office I inquired as to how long the approval would normally take for someone who met the BMI requirements etc. (basically a perfect candidate) as I had read various timelines.  I was asked my insurance and I said exactly what my card said, Oxford / United Heathcare.  The woman on the phone told me just a couple of months.  I said that was wonderful as I had heard some people had to go through a very long approval procedure, etc.  I tell her how relieved I am, blah blah.  I was so happy I was crying when I got off the phone.  Finally a solution I can work with for the rest of my life.

So last night I show up at the seminar and they scanned my insurance card and hand me a customized packet.  I go to my seat and look inside and I notice that one of the sheets say that I have to go through a SIX MONTH medically supervised diet and exercise plan.  WTH?  That's not what they told me on the phone.  I was completely crushed.  So I go back to the registration desk, tell them what I was told and basically get accused of lying.  I tell the women at the desk I have no reason to make that conversation up and that's what I was told and I feel misled.  They explain that my insurance is Oxford and not United Healthcare.  I explain that I read exactly what was on my card, Oxford / United Healthcare when I was asked.  

All I have been thinking about and looking forward to every day for the past few weeks is this surgery.  Dr. Eid comes over and I tell him what happened and he tells me there is no way around the six month program.  With appointment availability and everything else, it will be 2014 before I get surgery.  There is no way I can last that long.  I am literally at the end of my rope.  I will not last another year.

I ask if any of what I have done counts for the six months and they tell me no because I had to have seen a doctor every month with notes about diet and exercise.  I tell them I was on weight loss meds and saw a doctor.  They tell me that unless the notes are exactly what they need, it won't count.  I can't believe this.  All the thousands of dollars I have spent and all the effort I have made doesn't count???  I have to do ANOTHER 6 months?  Seriously?

So I say I'll probably do self-pay in Mexico.  The nurse acts like it's the most hideous thing she has ever heard.  Seriously?  

Is there any way around the 6 months with Oxford if I detail my efforts to date?

What is the true cost of a VSG in Mexico?  What about follow-up?

This is from your insurance company and no there is no way around it unless you self pay. Many of us have had to do it, it is very common. Have you checked with your insurance to see if they cover weight loss surgery because not all of them do. Every employer has a different coverage, so that is usually the first step, the surgeons office doesn't know all of the coverages out there. So I would suggest contact your insurance company first and have them send you the requirements if they do cover WLS. Good luck but we've all been down this road too.

Yes, I did check with them and they do cover the surgery and I do meet  their requirements to qualify.  That is why I contacted this particular Dr's office ... because he was both in my city (I don't drive) and they accept my insurance.

I'm so sorry about all your struggles. I understand your impatience.

I was sleeved by Dr. Aceves in Mexicali for $8,750.

How did you get follow-up care?

His base price in his ads is lower.  How does he structure his price?  Were there additional fees?

I'm not sure about the ads. I know the price is $8,750 (at least it was three weeks ago when I was there). If you go through a medical loan financing company to pay, some add fees. It includes everything but your airfare to/from San Diego.

For follow-up care, I spoke with my PCP before surgery and asked if he'd be willing to order my post-op lab tests and he agreed. I can email Dr. Aceves' patient coordinator with any questions, and she responds within 24 hours. So that is my follow-up care. Definitely not very extensive, but that is one of the drawbacks to having surgery in Mexico. Paying more to have surgery in the US was just not a good option for me. I am happy with my decision. I think Dr. A. does great work, the hospital was nice and clean, and I am confident in my ability to work my sleeve despite minimal after care. But surgery in Mexico is not for everyone.

I'm happy to answer any other questions.

Hi,

I'm sorry this is so frustrating.  I had to do a supervised diet, but it was only 3 months.   I took it seriously and lost 50 pounds before the surgery.  I had surgery 3.5 months after I started the process, and I was so glad that I lost the 50 pounds before it. 

I hear your frustration, but I wonder if you could take those 6 months on the supervised diet, and make a serious dent in your weight loss.  Then you'd be working towards the goal immediately. 

I wish you the best, whatever you decide.  I know its hard to be patient once we decide to take action, but as long as we are taking steps to be healthier, its all part of the process.

Hang in there, and I wish you well.

Carol

Thanks Carol.  I have taken every effort seriously in the past decade.  I have already made a lot of changes to help ease the adjustment to what will be my new lifestyle.  I just don't have it in me to make it through another year like this while on another "diet". 

I understand your frustration. Life is full of that. Your post gives me a lot of anxiety, so you must be SUPER full of anxiety.

People make mistakes, it's our own responsibility to understand how our insurance works. Perhaps the gal on the phone misunderstood what you said. Or perhaps she is just uninformed, or too lazy to check on your particular insurance, or confused, or has her period, or just broke up with her boyfriend, or hates everyone and loves giving out misinformation. Whatever the cause, if the doctor's office has some knowledge, then great. But in the end, it's up to us. Insurance is a crazy complicated thing, especially for this kind of surgery.

And wow....if I didn't like my trainer, I'd get a different one. In fact, I asked when I paid him (yes, expensive, $6000) "What if we don't get along?" He said there are four other trainers at his gym I could use, or I could go to another gym if necessary. Fortunately he's a great trainer.

I don't mean to be a jerk, or mean, or judgmental. I'm guessing people will bash me just the same....but I'm just wondering if some of your angst may be brought on by yourself, and could be dissipated by your own self as well? It's a good skill to have--to sort out what I'm going to get all uptight about--and one we certainly need to be successful in this journey. Feeling like the world is against me doesn't do me any good. Sorting out the issues and taking control of the things I have control over....that's what helps.

On another note, if you go to Mexico, I think from what I've seen others say, that you should pre-find a surgeon and nutritionist and support group in your city. Make sure the surgeon is willing to take you since someone else did the surgery. You might want to post that question on its own to get insight from those who have done it.

Good luck. It's worth the wait and the effort to get this done. It's lifechanging.

I also had to do the 6 months after I didn't think I would have to.  I had tried a couple years ago and got discouraged when I had to wait the 6 months.  Well....2 yrs later I was still fat and back at the dr trying again.  If I had just done it the 1st time, I would have been over a year post-op by then.  So I made up my mind that I've been fat for 20 years....6 months will go by in a hurry.  I remember my kids saying at Christmas it will be forever before school is out.  Well, school is out, and it went by fast.  Six months  compared to the rest of your life is a blip.  I was amazed how fast it went by once I made up my mind.  I had lots of "food funerals", spent lots of time getting recipes for bariatric foods and trying them out, and just got mentally ready.  If you are unsure of doing the self pay route, just get the ball rolling on the 6 months.  It will go by faster than you think.  Just think, if you have your surgery in January, you will be down sooo much by the time summer comes!!!