Caught between a rock and a hard place

I want to have the gastric sleeve procedure.  I'm a RN, and the insurance company won't pay for my surgery because I haven't been with the hospital for 24 consecutive months.  I work for Orlando Health and have HealthChoice Insurance.   I worked there for over 10 years, left to take another job, and came back a little over a year ago.  They want me to wait another year.  I've lost weight (>100 pounds) at least 3 times and always gained it back.  I don't want to be 200 pounds for another year, and if I lose 20 pounds I will no longer meet the BMI criteria.  My highest weight was 272, my lowest adult weight was 127 after losing almost 150 pounds.  My weight this morning was 198.  I'm considering going to Mexico to have the surgery.  I've been researching Dr's and facilities there.  Most of what I read is very positive, but I can't help but think you can't always believe what you read on line.  I'm considering Dr. Ortiz, Dr. Aceves and Dr. Alvarez.  I would appreciate any advice you can give me.

Can you appeal the decision for the reasons you stated?

Mexico - what if you have complications post op?

no,  because I haven't been working there 24 consecutive months.  Can't argue that, it's their policy.

You can argue you have prior service.

I do have insurance coverage..... I just don't qualify for the VGB (Vertical Gastric Band) procedure based on their criteria.  By the way.... I had a friend that went to Dr. Kim for the RNY.  She did well, but had been in remission from Cancer and her cancer came back.  She passed away last year.  She looked amazing, and had no probs from the bariatric surgery.

I love love love Dr. Kim! He and his staff are AMAZING!

Hopefully they'll have to treat post op complications... they'll treat symptomatically I would think.  I guess I should call the insurance company, but I'm still going to go to Mexico.  I really have no significant medical problems, so hopefully I'll be OK.

I am half way thru Dr Kim's process on the way to r-n-y His program has lots of post op followup needed after the inital surgery.

Lots of rules to follow else you gain the weight back over time.

Good luck to you whichever way you go.

The sleeve is different from the RNY or the DS. 

Dr. Kim also does the sleeve. They do take self-pay patients, and those patients have less of a wait time because the don't have to jump through insurance hoops. Also, if you have the surgery elsewhere, you can join his program for a $600 fee, and that includes lifetime followup.