1st post / Insurance Panic Attack

May 03, 2013

So, this is my first post.. I'm not really sure how I'll be using this forum, but here goes nothing.

I have been considering WLS in the back of my mind for some time now, but never really thinking it was a "real" option for some reason. I had only ever heard of "Lap Band" and "Gastric Bypass" surgeries, both of which unsettled me. I don't like the idea of anything foreign in my body. I already have 2 screws in one of my knees from and ACL repair and that is enough man-made material for my taste. The bypass seemed like the next "best" option, but the idea of having my intestines completely rerouted scared me. After reading about the "blind stomach" aspect, the bypass was completely out for me. I decided that WLS wasn't going to happen for me if I couldn't wrap my mind around what I thought were my only options.

Fast forward a few years. I visited my old job (where I am still a customer) last fall and saw one of my old coworkers, who I knew had battled her weight for years. I was shocked and excited to see that she had lost a TON of weight. When I asked how she'd done it, she said two words: "gastric sleeve". Sleeve? I had no idea what it was but when she explained to me exactly what the surgery entailed, I thought "Now THIS is a surgery that I might consider... IF I ever had surgery." Then I started thinking, "Why not? What's stopping you?" And my answer was immediate: cost. I'm a single teacher on a budget. I have bills that include a car payment and canNOT take on huge hospital bills. I have insurance through my job, but have never had a reason to need to examine my policy too closely. When I looked at my policy, it said that WLS. IS. COVERED. It was time to start this journey...

I spoke to my PCP, who agreed that VSG would be a good idea for me. She said she would write a Letter of Medical Necessity, and recommended a surgeon. When it turned out that her recommendation had just retired, I decided to use the surgeon that his office recommended, Dr. Jack Rutledge, who, as it turned out, sleeved my successful friend. When I called to make my appointment, I was advised of the required seminar, which I attended in December. I met my surgeon, who I liked immediately before even hearing his statistics - a good sign, I felt. I met him and his team in January at my consultation and felt very comfortable around everyone in the office. My weight on consultation day was 280. Dr. Rutledge and I agreed that I would have VSG surgery in May (it has since had to be rescheduled due to Dr. Rutledge being out of town on my original date). According to his office manager, as long as I turned in all of my requirements - letter of medical necessity (check), weight history (double check), attend the nutrition/mental health consultation (triple check),  and don't gain any weight (ummm... almost check... I'm up 6 lbs, but I'm pretty sure I'm bloated), then I'd be good to go as far as my insurance is concerned.

Fast forward to yesterday. I've been counting down the weeks until my surgery date, when suddenly the surgeon's office manager emails me to let me know that I have a "Pre-existing Condition Limitation Date" on my insurance. I would have to wait until I'd been on my current plan for a calendar year :( There was nothing else to it. I couldn't have surgery until August 7 at the earliest, which happens to be the 1st day back to school this fall. So really, I'd have to wait until Christmas break. Another 7 months to wait. I felt helpless. All I could do was pray about it and try to decide if I wanted to pay out of pocket. I emailed back to ask what my cost would be and the manager told me that it would be proportional to the amount that my insurance WOULD pay. When I called the insurance company, I asked about the "Pre-existing Condition Limitation Date" and it turns out, since I was a customer of that company before I got insurance through my job, then my limitation date was retro-activated back to the beginning of my old policy... Long story short, I. COULD. HAVE. SURGERY. IN. JUNE.

I am so ready to get my life back, I can't even begin to describe it. I will be having VSG surgery on June 17th, good Lord willing, and I couldn't be more ready! Feel free to pile on the advice and suggestions!

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