mexico vs insurance
So originally my plans were to head to mexico in march to have the vsg. And then my hours at work got cut so I was able to recieve government benifits. Now I have t be on 6 month supervised diet plus other test and things. How does the process work I know they want you to lose a certain amount of weight but do the insurance look at the weight when you first start the 6 months or after you lost-what othe things can get in the way of me not hhaving surgery and will they tell me I'm approved before I'm done with my preop qualification- hooefully I don't waste 6 monthd doing this and they deny me and then I end up going to mexico any
Typically insurance companies (including the ones that administer govt benefits) look at weight at the start of the six month period rather than the end, but it can vary. There should be an insurance coordinator with your surgeon's office who will know all the ins and outs and be able to help you with your specific policy and benefits. There should also be a written document or handbook ("member benefit handbook" or something like that) that puts everything in writing. If there isn't, see if you can get one. Stay in touch with your insurance/benefits rep and your surgeon's office as much as possible and get as much as you can in writing.
The surgeon's office should submit you for approval after you have done the six month supervised diet and all the tests. I had to do the same thing and it was nerve wracking! Everything was fine in the end though.
My insurance didn't cover it so I was a self pay. My husband wasn't on board with me going to Mexico, and now that I'm 3 months post op, I'm glad I didn't... I ended up being a self pay and traveling 6 hours to Salt Lake City, UT (I live in Boise, ID). While Mexico would have been cheaper, the hassle I saved myself was most definitely worth it. Knowing that I could hop on a plane and be there in 45 min if there was a complication which could have been expensive was invaluable to me (and my husband!). Thankfully I've had no complications, but it was a big concern for me. I had to do the math of not only the surgery, but what it would cost should I have a complication after the initial surgery and hospitalization. My insurance wouldn't have covered any visits related to the surgery either, should I have needed to go into the hospital locally as a result of surgery.
Because I was a self pay, all I had to do was the basic pre-op which wasn't even 2 weeks long. If I could have saved the money and gone the 6 months supervised diet route, I would have. At the very least, it would have helped me prepare for the lifestyle post op. But I'm pretty happy I did it, one way or another. Its very frustrating though that as a working, contributing member of society, my insurance didn't cover it and my barely above poverty level income is too high for government assistance which DOES cover it so I had to pay for it myself... but that's a whole other issue! If obesity is such a crisis in the U.S., why isn't the only proven long term treatment of it a mandate of the ACA?? But hey, at least my husband has maternity coverage for himself now... So aggravating...
While I was anxious to get the surgery asap I am glad I had to go through the six month process. It'll give you time to learn more and prepare for your life after the surgery. Plus, for me, the six months went by fairly quickly.
If your insurance covers it, and you fit the requirements (BMI, and/or co-morbidities) you should be fine. If they do deny you in most cases an appeal will do the trick. I didn't have any co-morbidities (doctor called me very healthy, and applauded me for taking action before my weight started causing illnesses) and I was approved on the first try.
The patient advocate at the hospital I had my surgery said she rarely sees denials, but they are very hard core about making sure they cross all the t's and dot all the i's when it comes to submitting paperwork to the insurance companies. I wouldn't worry about it. Chances are all will be good.
