Bummed

I went to Mexico for a lap band, but I wouldn't even consider it for an RNY.  There can be complications with any surgery, but any time you open up the digestive tract, those complications must be addressed swiftly and decisively.  I would only consider a local doctor.

Another thing to consider-if you came back and had complications, all local treatment would be full cost for sure-no helping hands from the docs here.  (and rightly so, I'm not bashing anyone). 

 I know you guys are right, but I want this sooooooo bad I guess I am willing to do just about anything.(i think)  
I may have another option, but I don't want to get my hopes up. I run a small business with my dad and right now we have community care through there. I am not covered on that policy because I am on my d/h's plan through his work. Anyway it would not matter because they don't cover it either. However, I talk to my dad this evening and he is willing to switch polices. The problem is we are such a small group, there will be a total of 4 people covered, that I don't know if we will be able to find a policy that will cover. If anyone knows of any please let me know. Sorry for all the whining. 
And thank you all so much for the advise and support.

I have heard of others who appealed their insurance company and got their surgery anyway.  I know that the weight wise folks will do it for you if you go through them.  I'm sure other doctors do the same thing too.  You never know you could fight them and win, others have.  I also know weight wise has a finance company they work with and I have a couple of buddies who did it that way.  As far as mexico, I would only worry about a complication.   Weight loss doctors here are busy with their own patients and who knows if you can get an appointment with one of them if you had complications.  Other doctors who do not specialize in weight loss surgeries really dont' know enough about it to handle complications correctly in my opinion.

 I have heard that if the policy has an exclusion there is nothing to be done. The Dr. I went to said if your police has an exclusion that they wont even file it.  Oh well I know it will all work out. 
Thanks for the advise and support!

I knew that United One would not cover it,as Golden Rule,United Healthcare,etc are all under the umbrella,and none of them cover it.( A-holes) Anyhow,i am self employed,and just switched to BCBS OK,through the Chamber Choice. I think in Sapulpa it would be Chamber Blue,but it is a plan that is offered to any self employed person if you are a member of the chamber.  You pay about 350/yr to be a member,and there is no underwriting. So you can be 550 lbs,but if you are self employed,and become a member of the chamber of commerce im your county you are automatically covered.

Anyhow,regarding insurance,i called and they say there is an exclusion,but get this...... I asked them if code 43843 and 43659 were covered under the plan,and she said YES however she said the plan has an exclusion. Those 2 codes,she said had a "need medical review" note. I asked Dr.B and my rep there,and she said they do not understand the situation either,and are going to wait until they get either an approval or denial,and we will go from there. This insurance crap is the pits!!!

Oh,as far as financing,there is carecredit.com..... capital one financing,chase health financing,surgeryloans.com. Hopefully we can both get something worked out for us. Good luck!

Thanks so much for the advise! We are a member of the chamber so I will tell my insurance agent to check into that asap. I will also tell him what you said about the codes and see what he finds outs and let you know. I also got on the Oklahoma insurance boards and printed out all the insurance co's that people have said that covered them and I will give that to him as well. I don't think he is going to like me much after tomorrow.  I agree this insurance stuff bites!  Please let me know if you find anything and I will do the same. Thanks!

I have united health care and they cover wls with three things you need (bmi over 40 over the age of 21 and have been obese for at least 5 years. When I worked at a hospital I had bcbs and they wouldn't cover the wls no matter what.
christina

Hey Christina,yes but it depends on what policy your plan has. All of UH will not cover WLS. Also,is your insurance through UH of Oklahoma,or UH of Missouri. BCBS will pay for WLS in certain states regardless,and i think Federal BCBSOK for sure,it is the non federal group plans for BCBS OK,that is giving me the pits. How can you cover certain codes that are weight loss/obesity codes but say that you do not cover WLS. And also,why does BCBSOK have 2 hospitals( Integris and Norman hospital)listed as Bariatric Centers of Excellence if they are not covering it. Somethings just make me go hmmm. I think they want us to fight.


OP,please keep me updated as to what you get on your end,and i will surely do the same thing!!

where did you get those codes, and what type of surgery are you having? I have already been told up front (Dr B) that my state insurance pays NADA, but that they will submit it with the letter anyway--because sometimes ins will allow it and they don't know why, and they certainly don't ask! My policy has an exclusion also. I am prepared to self pay but hope of course that I don't have to. I saw my new PCP on 2/17 so my referral for the other clinic charges will be covered...should get the notice any time now. Then I can schedule eval and go on with that.

Lisa J

We got them online.  I am wanting VSG although Dr. B said he thinks RNY would be better for me as a sweet eater. I still will get the VSG if at all possible.