Insurance to cover WLS?

Hi Everyone! I'm wanting the WLS pretty badly and need some help. I know Voc Rehab is not covering the surgery anymore. But, I'm looking at a separate insurance policy that will cover the surgery. I'm willing to pay the extra $200-300 a month so I can get the surgery done. Has anyone ever done this? For the ones that have had the surgery done, what insurance do you have? Was it good/bad? Does your insurance sell individual policies? Medical financing is not an option. I already tried them and was denied. Does anyone have any other ideas on how I can do this??? Please any advice, suggestions or whatever would be greatly appreciated!! Thank you! Karine

Can't really help on the insurance issue, but GOOD LUCK!!! Hugs, Connie

I don't know your finicinal situation but if you meet the income requirements at UMC then all you have to do is pay the surgeon up front. I paid in $7,000 and the hospital wrote off the $20,000 Joyce

Joyce, what are the income requirements? Any idea who I would call at UMC and get some information?? Thanks for the info!! Karine

Karine, I was set up to go thru voc rehab when they pulled the plug on that service (I found out three days before I went to see the surgeon). I then seached the seperate insurance policy route, but the only few insurances I could find that actually would pay for WLS, their premiums were around $500 per month and you had to be on the insurance for 6-12 months before it would cover surgery. I had given up hope when some friends told me that CMMC was offering a discount price for cash payments. We decided we could take out a second mortgage on our house to cover the cost of the surgery by using the discounted price at CMMC. The discounted price is good for surgeries done by June 30th, however I have heard that they might be extending this deadline. If you are interested, let me know and I will give you Adam Dungey's email at CMMC. I just had my surgery with Dr. Cleveland on Monday, May 22nd and I am so thankful that I went this route. Best Wishes, Marci

You could get a loan and pay cash for $200- $300/month. I actually took out a loan for more than I'd need ($30,000)...did some debt consolidation, had surgery, went on a vacation etc. My payments for a 5 year payoff is around $480/month. I wanted the extra up front just in case of an emergency...because you do need to consider that if you're paying cash and any complications occur--that you're going to have to pay for that, too. (guess that would be a con for paying cash vs. insurance) Speaking from experience, though--re: complications. I was self-pay a few years ago for the band. Two years later they removed it because I was throwing up blood. My insurance company refused to pay ANYTHING for removing the band because they felt it was related to having the band in the first place. Actually, I was one of those who vomited a LOT with pregnancy---so it really wasn't related to having the band but more related to pregnancy. So be careful of any potential problems you may have in the future which aren't necessarily related to your procedure but the insurance company could try to say it is. good luck on your path, though. explore all your options. mary

Mary, How much did you have to pay cash for the RNY? Was this done by a doctor in Jackson,MS? Also, comparitively, when you had the band and it was working, ....how did it compare to the bypass? I have heard on the boards that with the band, you are still hungry....just curious... Thanks.

I had the RNY by a doctor here in Jackson who doesn't advertise that he does WLS. He is a general trauma surgeon, but I'd heard that he did WLS. I'm a nurse and had taken care of lots of his patients in the past and trusted him alot. I've been very pleased. I had to pay up front somewhere around $300 for the initial consultation. The surgery itself was $6000 up front. That was just the physician's part. Labwork, xray, hospital at River Oaks (that's where he does this surgery) was $23000 (because I work there and paid cash up front I got a slight discount to what I was origionally quoted). If you talk to the financial counselors at the hospital, they can give you the best 'deal' available (again, this varies depending on how full the hospital is, etc. they can change some things and lump others together--but they are going to want it up front). The anesthesiologist is another $1300. The physician I used offered to get me setup with a nutritionalist pre-op, but I declined. I also did not have a swallow test post-op. Again, this is unlike most physicians who do the RNY. I didn't have to do the psych eval., sleep test or any of that. When I had the band 5 years ago, it worked wonderfully. I had the nonadjustable band (Dr. Molina did mine, but his predecessor is Dr. Oria in Houston, TX). Ironically, I had the band placed the day the FDA approved the adjustable band. I had great results---lost 160 pounds in under a year with the band. I did feel hungry with the band at times, but I could only eat two or three bites at a time. I couldn't even drink but a sip or two. I always felt the 'pressure' of the band on my stomache and was reminded not to eat much. I did feel hungry sometimes, but after a few bites, I'd be uncomfortably full and learned to stop with one bite. Was great in that I only had a bite of something good or a bite of something bad (health wise). Oh yeah, you were asking the price. Dr. Molina had a special setup with Spring Branch Medical Center (and to my understanding Dr. Oria has the same deal) and it was a lump sum cash payment of $15,000 (that included hospital, surgeon, anesthesia, etc.) Bear in mind that was 5 years ago and surgery is much more popular, accepted and cheaper than it was then. Having the RNY has been completely different from the band. I've never hurt on the inside which is something I expected. I always felt the band with me, so I felt restricted....felt different. Nowadays I sometimes stop and remind myself that I really am okay and that I'm not really overeating though some days I feel like I do because I actually eat 3/4 of a burger instead of one bite like I would have with the band. oh--and with the band i couldn't tolerate any bread (it would stick)....so i was completely breadless for almost 2 years. Now I can eat it, but be satisfied with a few bites, but still feel like I'm living life to the fullest. Whatever you choose, just realize that each person's 'reaction' to surgery can be different. I.E. some bandsters can eat anything they want whereas i couldn't tolerate any bread or carbonated beverages. some rny'ers can eat sugar and others cannot even lick it without dumping. these procedures are different for everyone. obviously i like to talk about this, so feel free to write me and ask anything. mary