Newbie poster intoduces herself

 Hi there, I am Ruth.  Pleased to me you all.  I am in the process of researching the DS surgery and have found the various posts on this board useful in both the posts and the additional links. I dont have a specific question or comment, but thought I would introduce myself before I jumped into discussions.

Hi Ruth. I'm Gina. Nice to meet you too. Do you have a surgeon yet?

--g

 Not yet. My insurance explicitly excludes all forms of bariatric treatment, so I will have to self pay. My HR lady thinks I can appeal given my diabetes, highblood pressure, and other factors. Supposedly I can get a letter of medical necessity from my PCP and appeal.  However, from what I've read, the exclusion won't likely win an appeal.  

My top choice for surgeon is Dr. Elariny in northern VA. From what I have read, he may be an option only if I can win an appeal.  Otherwise Dr. Stewart in TX would be my top self pay option.  I haven't spoken with any of the offices yet because I need to get my PCP on board with my decision. Also, my insurance changes at the beginning of the year.  I figured I would not bug the specialists until the payment options were figured out.  All things being equal, I would prefer Dr. Elariny since he is two hours away.

I would love to hear from anyone who attempted to appeal when wls excluded or anyone who self paid with Dr. Elariny. Sorry for any typos, I am respond on my phone.

oh, forgot to add my stats. I am 5'2" and 353, which puts my BMI north of 60. I decided to go with DS because the rate of remission for type 2 diabetes and the fact I need to lose approximately 230 pounds to get to a healthy BMI. My biggest issue is that I have been dieting for the past three months and lost 25 pounds. My PCP might say to keep doing what I am doing and forget about the surgery. I will know on Friday since I have my three month diabetes appointment. I still plan on taking medical paper abstracts cited on dsfacts regarding the differences between gastric bypass and DS, diabetes remission rates after DS, and the diagrams showing what a DS is. I am well prepared,so hopefully he will have an open mind.

It's expensive up here for self-pay and even if you were able to get your insurance to cover, Dr E charges additional for the DS. But talk to Alex, Dr E's insurance guru, and attend his info session regardless. The other surgeons you mention are top notch as well. Totally understandable if you want to see one of them.

--g

 I will make a call to the office to get a self pay quote. LOL - I already have a spread sheet going for this topic.  I need to factor in cost of travel, staying in town for 2 to 3 weeks, dog kennel fees,cat sitting fees, cost to take off work, and probably a billion other things I have not considered.  I need to do this, so hopefully I can find a workable solution.

Are you referring to the upfront fee collected at intial consult?  I cannot remember if that was for all wls or just the DS.

You don't have to pay the program fee any more but there is an extra charge that you pay just prior to surgery that covers the difference in what insurance pays and what Dr E charges.

 Thank you so much. I guess I am at the point of making calls since the websites don't seem to be current.  

 I used to have the self-pay quote but now can't find it... it was pretty high.  Dr. E's surgeon's fee is $12k, and you would have to pay that regardless of insurance.  

I will say though I think he is a pretty fantastic surgeon.  I had surgery three weeks ago today, 2 nights in hospital, home and doing fine and eating ... and eating WELL... no complications, nothing.  

 Wow, that is a lot more than I was expecting, but I can understand why.  I am going to call the offices this week and see if I can get a self pay rate. The more I am learning about the insurance stuff, the more I am starting to accept the fact I will probably be self pay.