Waiting for insurance vs. self pay.

Give insurance a shot, they can surprise you. I anticipated a fight with mine, but it was approved with the first request. I did have to do a 3-month supervised diet, but that wasn't a big deal compared to financing a Mexico trip. High cholesterol counted as a co-morbidity for me, though my BMI was over 40 so the co-morbidities just added to the reasons to approve it without a fight. I also had sleep apnea and arthritis, but no diabetes or some of the other standard co-morbidities they consider. I would imagine that each insurance company considers PCOS differently.

If you get denied, you still have the option to self-pay. But I'd try it at least.

Good luck!!

First order of business is getting in touch with your insurance company to find out what they require for surgery to be covered. Call the phone number on the back of your card and ask for the coverage guidelines.

Thanks everyone !! My insurance requires a BMI over 35 if you have at least one co- morbidity. So I do qualify but they could also fight it if they want to. I have been researching Mexico as well as a back up plan and am surprised how many people have gone there. My sister got plastic surgery in Colombia and had a good experience so I am not totally against the idea of travelling abroad . I just don't know if I should be patient and give insurance a go first. I am already going through the process of all the requirements ( Psych eval, dietitian , chest x-ray, endoscopy etc.).

If you can get it covered and get regular follow up after surgery near where you live then it is definitely worth trying. My BMI was 37 when I started the pre-op diet and I didn't have any health problems outside of PCOS (which did not count for my insurance), so my only other option aside from Mexico was to self pay about 21k. If I had the option to use insurance, even if it meant delaying surgery for a few months, I would have done that.

I've had problems for years that have caused me weight gain. Those problems are related to an overproduction of a hormone in my stomach that causes hunger. I have considered weight loss surgery in the past disregarded it after complications when my mom had weight loss surgery in 2001. She died in early 2002. She died of lung cancer that would have been present when they did her weight loss surgery but it was never caught.

My weight has fluctuated a bit over the years with the highest weight that I have had of 333 pounds right around the time that my mom died to as low as 267 pounds just before my son was born in 2009. Various stresses in life have caused these fluctuations and I've never been able to truly get down to a normal weight. A few years ago I gained 30 pounds just by quitting drinking diet dr. Pepper. It turns out that I was allergic to the sweetener used in it. I was having multiple medical issues and almost all of it went away when I quit drinking diet dr. Pepper. Then due to my metabolism slowing down from the lack of caffeine my weight started to increase. In eight weeks from the time that I quit I gained those 30 pounds and I haven't been able to lose them since. I have been through all kinds of different diets throughout the years. The one that worked the best for me was the Atkins diet.

Two years ago my doctor mentioned to me that I would be an excellent candidate for weight loss surgery. Through doing a bit of research we found that an ulcer caused my hormone imbalance in my stomach that we were unaware of. That hormone was 8 to 10 times higher then and somebody in my otherwise same shape. Half an hour after I would eat my levels would be 26 to 28 times higher.

I spoke with my insurance company and they do not cover weight loss surgeries. I considered my options and decided to stay as a fat man for a while. My job requires that I have a commercial driver's license and I had heard rumor that the Department of Transportation was planning on changing the requirements for the medical card that if you have a BMI of 35 or higher they would require you to prove that you do not have sleep apnea. I do not have sleep apnea, it can be picked up on an overnight oximetry. I have used an oximeter many times but that is not considered proof.

The combination of the Department of Transportation regulations changing and knowing that I physically had a problem with me made me decide to do weight loss surgery. Fortunately my boss, a respiratory therapist, had weight loss surgery last year in Tijuana Mexico. From talking with her I found out that two of her family members both members of the medical professions also went to the same doctor in Mexico as well as her dad and a friend of theirs. I met with all five of these people and came to the conclusion that I was extremely comfortable with the surgeon. He has an amazing track record. He has performed over 3,500 surgeries with never so much as a single infection. The three people that I know in the medical field all said that this is the cleanest facility they have ever been to period.

The decision was made and I was comfortable after doing some research on my own. What I was unaware of is that part of this Medical Group also does stem cell therapy, immunotherapy ,cancer therapy, and they are also able to completely stabilize most medical issues.

My wife and I were so impressed with everything that they did for us and everything that we saw. We were treated like family not like patients or a family member of a patient. They have the ability to cure, not treat, but CURE my wife's lupus. We plan to do whatever it takes to return there next year for her. Very impressed.

I am also a member of a bariatric website. What I'm posting below I have posted on that website. Hopefully this will open some people's eyes to the quality of Medical Care and the possibilities that are out there. I will say though make sure you do your research! There are many bad companies down there as well. Please don't hesitate to check out somebody through the Mexico board of Medicine.

So yesterday was my day to get the sleeve. I'm down here in Tijuana Mexico with doctor Mauricio gutierez at Trinity Medical. I got down here on Sunday and they treated my wife two tacos for lunch and lobster for dinner at local restaurants. They also took us sightseeing. One of the restaurants was absolutely gorgeous out on the coast. Everybody that we've met here has been beyond anything I've ever received in the states. I have to admit that shortly after the sleeve I was in quite a bit of pain but I'm over that now. Most everything is just a little discomfort. In about 10 hours I get to have my compression socks off anb the IV removed. Part of their follow-up care while I'm here is to take us shopping. While doing so they will have a member of the staff pounding on my back to help with releasing the gas. I couldn't have been treated better.

Little bit of strangeness last night. I rolled on my left side and I felt what can only be described as a fart inside the tissue of my back. It scared the heck out of me. I immediately rolled back on my back and let out a rather large burp. I did find that rolling from one side to my back and then over to the other side and back to my back got a lot of the gas out. Kind of interesting.

They are taking my sweetie for an hour of massage this afternoon. We're getting treated nicer than we've ever been.

One thing that I'm quite happy about is that everything went good during my pre op so they didn't need to put in a drain. From what I've heard that is the worst part of this. They estimate that my liver shrunk 40-50% and I didn't have bleeding. Whew!


Everything is going well. I'm definitely weak and tired. I slept 18 of the last 24 hours. I overdid it yesterday by trying stairs and I paid for it. We will be back home tonight around 8pm. All that is left is x-rays and a leak test in the morning and I'm good to go.

This morning I got to see the flip side of things. I mentioned xrays and a leak test. We did that in a different hospital. I saw 4 other people who looked like death warmed over. They were struggling bad. We overheard that one of the girls had a leak and it will obviously have to be repaired. Scary stuff! My xrays and test were great. I'm in the San Diego airport suckling on vitamin water and looking forward to being home.

Ahhh the joys of home! Home that place where my devoted chocolate lab (chocolate moose) was so excited that she started jumping the moment that she saw me. I just barely kept her off my chest. It is also where our neurotic, psychotic love ball of a cat launched onto me in the middle of the night. Ouch! Needless to say he got thrown out of the bedroom with the door closed behind him! He has been a purrrrrfect angel this morning because he knows that he screwed up.

I started the liquid diet on 8/19/16. My surgery was 8/29/16. I have copies of all of the blood tests, the EKG, the X-rays and everything that was in their chart notes. So far I have lost 25 pounds and 10.5 inches total. I've already dropped a notch in my belt.

I remember you posting these! This helped so much as I was preparing for surgery, thank you HFFM!

I'm glad to hear that it helped someone!

I would go through with all the testing and try to get it covered by insurance ... frankly saving 10 grand (at least) is worth the few extra months. Have you had the sleep apnea test yet ... because that could be your 2nd co-morbidity.