I shared my story on my personal experience with insurance companies.   I am one of those people who absolutely positively needed to have my insurance pay for wt loss as I was told by two orthopedic surgeons that if I did not lose 100 pounds in less than six months so they could operate on my knees and my left ankle that I would not be walking in a year.     See my post about additional information. I decided to take out a home equity loan since my home is paid for, which is truly sad.    I have to now pay for this surgery so that my insurance company will cover the knees and ankle surgery.     I am going to my local news station to have this advertised and offer to allow them to follow my case.  I feel that my situation might be unique in that I was prepped for surgery at a local hospital in Tennessee so that I could have the very much needed surgery on my knees and ankle but the anesthesiologist cancelled the surgery due to my risk.   Remember, even after this, the insurance company said my obesity surgery would be to cure my obesity, never mind the fact that it is required I lose 100+ pounds in six months or as soon as possible.   A letter from my internist, a letter from my first ortho surgeon and then another from a 2nd opinion ortho surgeon was to no avail. I believe insurance companies such look at each case individually and assess whether or not it is medically necessary and pay if it is.     NOW THE GOOD NEWS! ..... I am going to bite the financial bullet and do it myself.   So.....wish me luck everybody.  I am looking for the right facility and right physician.    I am looking to have it done under $15,000.00.    I want the mini gastric bypass.      Any ideas out there?  I want to have surgery in April.   I have no issues going outside the US. THANKS!  

Hi again!  No, I did not get insurance coverage for the MGB.  My insurance does not provide any out-of-network coverage and only covered WLS 50% last year and does not cover it all this year.  So I decided to pay out of pocket, because the copay for the surgery here would have costs over the $17,000 that I paid for the all-inclusive MGB.  That fee covers all the treatment while in the area of your surgery.  I had to stay in the hospital an extra day because my blood pressure was a little high, and that was covered in the $17,000. If you read the RNY boards, you can see all the complications these people have.  I know people who have gotten incisional hernias, ulcers, and obstructions.  MGB patients do get these problems, too, but I do not hear of them as frequently as I hear about the RNY patients.  Think about it:  There's one connection with the MGB and two connections with the RNY.  Obviously, that opens the patient up for more problems. As far as weight regain, I personally know four people that have gained back about 50% of what they lost.  I don't want to go through this whole ordeal and gain my weight back and still be vitamin deficient.  How awful would that be?  The people I'm talking about were about 2 years out when they started gaining.  They must have stretched their pouch out or something.

I live in Indiana and had my surgery done in Michigan, about 5 hours away.  It didn't really concern me, because I have a lot of faith in my family doctor and I knew she'd be able to handle whatever came up, which the only thing that happened was I got dehydrated due to my own stupidity!  She just orders my blood work and then calls Michigan if there's any questions.

If you have any more questions, please let me know!

Julie

 

Hi, Gail!  You've made a good choice looking into the MGB.  View my profile for more info.  Also, you can go to clos.net.  It's not the best site, but go ahead and look anyways.   As far as I know, the closest site to you would be Las Vegas. Best wishes, Julie

I don't think the insurance companies take it lightly, I think they clearly don't want to pay for it for fear of the millions of morbidly obese people that would make claims.  So they make it difficult (the number 1 most denied insurance claim in America!), they put up hurdles like diet history (and they often don't pay for the conventional program that many of them require before you can get precert for surgery).  They send out a lot of initial denials because many of us will go away.  Many of us are so beaten down, so depressed and feeling "unworthy" so we do in fact go away.  The key to it all is exactly what your ID says "Never give Up!"  The squeaky wheel does seem to get the oil.  I am working on squeaking my heart out right now and will not stop until I get what I need and I am entitled to ... healthcare coverage from my health insurance company!

As for the MGB go for it, but get prepared to make a case that the MGB isn't "experimental" surgery.  You may want to contact CLOS and tell them that you want to get approval for it and ask them to send you all the documentation and studies they can to support the fact that it is not "experimental."  that may be tough since they are the only ones doing the procedure, but you never know.

You go for it girl!

Keep us all posted.  I know there are many people who would like to have that procedure.

Jennifer

Hello All: For newbies and not so newbies, I just wanted to let you know that there is a forum on Obesity Help called the Black American Forum (BAF). If you are not familiar with it, please feel free to stop by to post comments, questions or concerns. Want to know how to get there: Click on "Forums" at the top of the page and you will see a drop-down menu Click on "Show All Forums" and you will see several boxes with forum names in them On the left side in the bottom box, click on "Black American" And then you will be at BAF Come by and post a comment. We would love to see you there. Grace & Peace Treena