Introduction 51 year old male

Hello,

I am glad to find this forum. My name is Bert, and I have been overweight for many years. My BMI is 38, and I have sleep apnea that caused atrial fibrillation before it was diagnosed. I also have high blood pressure, cholesterol, and triglycerides. My A1C is at the pre diabetes level, and I have very bad arthritis in my right knee due to old football injuries and operations. 

I have been denied weight loss surgery by my HMO (Kaiser) because, in the doctors words, I "do not look fat enough". The doctor admits that I meet the requirements, but refuses to even start the approval process. 

I am planning on being a self pay, because I want my life back. I have finally decided that I am worth the money, and will definitely start looking at my options. I have contacted one clinic in San Francisco, and they told me the cost will be 14-17,000 dollars. I could do this. It would hurt, but it is doable. The other option is going to Mexico for 5-7,000 dollars. I am hesitant to go that route, because I do not know if it is safe there. 

I would love love some opinions on my problem. Are these typical when dealing with insurance?  Do any of you have experiences with surgery in Mexico?

thank you for reading,

Bert

Hey, Bert!  :D  That's some kind of BS with Kaiser.  If you meet the requirements, you meet the requirements.  Can you do an appeal?  Is there a Bariatric coordinator at your facility?  There must be some sort of higher-ups to appeal to.  I would exhaust all of your options there before going the self-pay route.

You haven't indicated which surgery you're planning on pursuing.  In order to get accurate information re: Mexico, you probably want to share that.  I know there are several people who have had VSG and RNY done in Mexico and done well.  I can't think of any DSers that had it done in Mexico, but they may chime in.  My own surgery was done locally and covered by insurance, but I've read about several good experiences.  I think there are also reviews of Mexican surgeons here on OH.

Good luck with your journey!

Jen

Hi Jen,

thank no you for the reply. The procedure I am looking to get is the VSG. I thought about fighting kaiser, but if the places in Mexico do quality work in the $5000 range, that is a small price to pay to avoid the stress of the fight, and then the waiting. 

Hi Bert,

Welcome to OH and the beginning of your journey. We are very sad to hear your insurance will not pay for your better health.    There are many members that have gone to MX and had VSG surgery successfully.  Here are a couple of links to help you.  Post on the MX forum and the VSG forum too.  We also have included some information on some surgeons from MX. Check out their profile, read the reviews and if you want further assistance we can help you with finding a surgeon.

Vertical Sleeve Gastrectomy Forum (VSG)

Mexico Forum

Thomas Umbach, MD, FACS, FASMBS Bariatric ... - Las Vegas   Thomas Umbach, MD, FACS, is a board-certified, fellowship-trained certified bariatric surgeon. Dr. Umbach is one of a select group of surgeons to be named a  ... www.obesityhelp.com/profiles/bariatric-surgeon/dr-thomas-umbach/

Guillermo Alvarez, M.D. Bariatric Surgeon - ObesityHelp   Dr. Guillermo Alvarez is a highly skilled Mexico bariatric surgery practitioner who specializes in numerous forms of laparoscopic bariatric surgery, including ... www.obesityhelp.com/profiles/bariatric-surgeon/dr-guillermo-alvarez/

Armando Joya, M.D. Bariatric Surgeon - ObesityHelp   Dr. Armando Joya is a world renowned expert on Lapband, Bypass surgery, and pioneer surgeon of the Gastric Sleeve surgery. No other doctor in Mexico has ... www.obesityhelp.com/profiles/bariatric-surgeon/dr-armando-joya/

Keep us posted on how you are doing.

Regards,

Cathy & Kathy

Member Services

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Hi Bert, my surgery was in Mexico on June 2nd.  I will be more than happy to go through my entire experience with you if you like.  I did the gastric sleeve... 

If you are not from San Francisco, the surgery in mexico and SF will be practically the same.  If you want to chat about it, send me a message and I will forward my number.

Juniper

Hi Juniper,

i would love love to hear all about your experience. I am from the Sacramento area, but it is pretty close to San Francisco.  When you say similar, you do not mean cost wise, do you?  The place I contacted says it is $4400 for everything. 

Hope per to hear from you soon,

Bert

Your comorbidities alone should qualify you for surgery.  Typical Kaiser junk.

Check out the Men's Forum on this site:

obesityhelp.com/forums/men/

Lots of good info there.

The San Francisco doctor is great for the DS.

You can force your insurance company to pay if you meet their requirements. If your present doctor doesn't want to start the process, fire him and hire another one. That's right---you're the employer and they're your employee.

Before you make your final decision about which form of WLS to have, research them ALL. You may have never heard of the procedure I had, called the Duodenal Switch. The DS has the same stomach as the VSG, plus an intestinal bypass that's great for treating or preventing co-morbs like diabetes and high cholesterol, and like the VSG, it allows you to take NSAIDs for your arthritis. (Losing weight helps, sure, but arthritis causes bone damage that just does not heal.)