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Post by georgiagirl on Dec 27, 2011 13:32:12 GMT -5
Hey all, I'm considering DS. I was diagnosed Type II six years ago, went low-carb, and control my A1C really well (fives and low sixes). I lost about 80 pounds, and my weight has fluctuated between 220 and 245 for the last three years. My cholesterol fluctuates between 230s and 290s and I can't tolerate statins and Zetia doesn't seem to help, though I tolerate it fine  . I exercise and eat low carb and know I can maintain those as a life-long habit. I am pretty sure my insurance doesn't cover WLS. I haven't called, but I'm pretty sure I remember that. My mom, who struggled her whole life with her weight and typeII died suddenly in her sleep last year of a heart attack, my dad has had two heart attacks, and I want to know I've done everything I can to help this. So my questions - is the cost greatly improved by going overseas? If I can find a supportive PCP? I teach school and I know I can afford the supplementation, but two in college, supplementation, and a $30000 or $40000 in debt would be challenging. If by some chance my comorbid conditions do qualify me for insurance, did you all have to do the physician supervised weight loss first? Would Weight Watchers count? There isn't a hospital program within an hour of home and it would be challenging to say the least to find time to work out that far away from home. Thanks in advance. |
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Post by Gail R on Dec 27, 2011 14:43:35 GMT -5
Hi and welcome, First I want to give you my condolences on the loss of your mother and the health problems your father is facing.
Diabetes does it's damage even when you are doing your best to manage it. I was suffering from kidney and liver damage due to its effects. The DS has the best record for reversing type 2 diabetes and wiping out high cholesterol. Your comorbidities should qualify you for WLS. In CA you can appeal the supervised weight loss provision and some other state most likely as well. Weight Watchers should count if you have the documentation.
The cost is greatly reduced by going overseas. Many have gone to Mexico and Brasil. There is only one doctor in each of these countries that is recommended and they get excellent marks. You should go to DSFacts.com for a list of surgeions and for much more information about the DS.
Good luck in your journey.
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Post by Joanne on Dec 27, 2011 14:55:26 GMT -5
Hi,
I'm glad you found this board. The cost of going overseas does vary. The only one to ever use in Mexico is Dr Ungson. Also in Brazil there is Dr Marchesini (sp?), his patients speak very highly of him. Dr Stewart in Texas has one of the lower self pay prices for US surgeons.
If your insurance covers WLS, the 6 month pre-op diet will be based on their rules and your policy. It's proven to not be effective whatsoever for your weight loss outcome, it's more of a hoop they make you jump through trying to weed people out so they dont have to pay. WW does count, document ALL of your efforts.
What is your BMI? If it is over 40 you dont need to comorbidities to qualify. If it's 35-40 you probably do. Self pay rules will be different and you should discuss with the surgeon.
Where do you live? We can help point you in the right direction.
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Post by georgiagirl on Dec 27, 2011 15:04:33 GMT -5
I live in north GA. My BMI seems to vary on different calculators, but 37-38. I've never really considered WLS before, but I've been researching options for the last several months. The statistical reality of even well-controlled diabetes from the age of 34 on to old age doesn't look good, so I'm seriously considering my options. I think I could probably get the weight off if I was REALLY strict with my diet and exercise (saying that as a person who is pretty strict now), but none of my comorbidities responded to losing 80 pounds - which was about 25% of my body weight. The numbers look really good on this surgery in particular. I don't think I would consider another kind of WLS because the switch seems to be the key in the comorbidities.
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Post by sherbearmama on Dec 27, 2011 15:04:34 GMT -5
Hi and welcome to the forum! I too have Type II diabetes. I had my DS just 3 weeks ago so I don't know how it's working yet but I'm sure it'll help. As to the supervised w/l, I'm pretty sure Weight Watchers would count. I tried appealing the supervised w/l requirement (I live CA) and I was denied by the Department of Managed Health Care. That was the sole reason they said they denied my appeal (which included other issues as well).
One of the well known and trusted DS surgeons in CA charges around $22,000-24,000 for the surgery. If it's cheeper to go outside of the country, just make sure to go with someone who is vetted and recommended by those here on the board.
Good luck!!!
Sheri
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Post by shrinkingruthie on Dec 27, 2011 18:59:16 GMT -5
Hi and welcome. There seems to be several of us in the same newbie boat. Iam also starting down the road of self pay.
If I may make the suggestion of checking out the surgery groups listed on dsfacts.com that are located in TN. I can't remember which group it is, but they do have it listed on their website. There is one practice that has built into the cost a 90 day after complications clause. If you happento have complications after surgery, it can cost a lot more and this self pay plan seems like a good choice. Of course, it is more expensive than going outside the US, but I thought I would let you k now what I found as I have been doing my research.
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Post by larra on Dec 27, 2011 19:02:49 GMT -5
Welcome!
You need to check your specific insurance policy to see if wls is covered, and if so, whether or not WW would count. Our speculation yes or no isn't the answer, your policy will tell you, for example, that the 6 months thing must be supervised by a physician, in which case you must be seen by a physician monthly for this and he/she must document in your medical record. Some policies will allow for a dietician, but again, get your policy, read it yourself, and don't trust anything that an insurance company employee tells you over the phone.
Next, if you don't have wls coverage, the deal in CA that Sandy mentioned may well be your best bet, so send them an email. If that doesn't work out, you still have options with Dr. Ungson in Mexico and Dr. Marchesini in Brazil, both of whom get rave reviews from their patients.
But bottom line, as much as we might want to help you, you need to know the specifics of your policy before you can move forward.
Larra
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Post by Seeking Healthy on Dec 27, 2011 20:21:16 GMT -5
Hello and just wanted to say welcome! You have already gotten some names of well respected doctors both out of the country and within so I won't bother to repeat that. :-) Just wanted to say glad you found us and good luck on the fantastic journey you are about to go on. Be sure to check out dsfacts.com as well. It has a ton of great info.
SH
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Post by shann_ds on Dec 28, 2011 8:51:18 GMT -5
Hi! I don't know much about self pay but I wanted to say that my type 2 has been completely controlled by my DS. I have had no problems with high readings since about 1 week out. Since my dad died of a heart attack, I totally get where you're coming from. The statistics from diabetes, high cholesterol, & high blood pressure are scary and are the main reason I decided to have my DS. Also, for my insurance (I'm a teacher in TN) Weight Watchers didnt count because it wasn't with a doctor. I wasable o go to my PCP each month for 6 months. I didn't lse a pound, but I jumped through that hoop and that was all that mattered! Good luck with your research and welcome to the boards!
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Post by jillybean720 on Dec 28, 2011 11:47:02 GMT -5
Like larra said, we can al offer you suggestions and opinions based on our experiences, but you need to get the specifics on YOUR insurance. I do NOT recommend just calling and asking - I have gotten incorrect or incomplete information multiple times by doing this. Instead, dig into the insurance company's website for provider documents - that's where they hide the goods! Of course, first step is to check with your employer (or whoever the insurance is through, maybe a spouse's employer or whatever) and make sure they have included the WLS rider. If not, if there is a hard WLS exclusion, then that's the end of that (unless it's a smal company with self-funded insurance plan, in which case, talk to your HR department - heck, talk to them anyway and see if you can convince them to include the rider at the next open enrollment!).
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Post by jjthejetplane on Dec 28, 2011 11:52:50 GMT -5
WW did not count for my 6 months of diet history. I had to see my PCP or dietician, have a start weight and then 6 more times each 27-33 days apart. They were very strict with mine and I ended up doing more months to make them happy. So like above posters said see if your insurance covers it and get your testing sleep apnea etc. And maybe they will help with the cost.
JJ
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Post by Joanne on Dec 28, 2011 12:05:22 GMT -5
Interesting that WW counted with my plan, but not for the others. Just goes to emphasize what all have said -- you need to check with your own plan and follow their guidelines. Some make you jump through more hoops than others.
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Post by Deleted on Dec 28, 2011 14:30:33 GMT -5
You can get it done in Los Angeles with the best DS surgeon for a ridiculous price because of a deal they are running. Email them for more information. The email address is: coehospital@yahoo.com You can send me a private message for more details. WHAT HO is that still happening? Great to know!!! |
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Post by msbatt on Dec 28, 2011 20:27:05 GMT -5
Hey all, I'm considering DS. I was diagnosed Type II six years ago, went low-carb, and control my A1C really well (fives and low sixes). I lost about 80 pounds, and my weight has fluctuated between 220 and 245 for the last three years. My cholesterol fluctuates between 230s and 290s and I can't tolerate statins and Zetia doesn't seem to help, though I tolerate it fine . I exercise and eat low carb and know I can maintain those as a life-long habit. I am pretty sure my insurance doesn't cover WLS. I haven't called, but I'm pretty sure I remember that. My mom, who struggled her whole life with her weight and typeII died suddenly in her sleep last year of a heart attack, my dad has had two heart attacks, and I want to know I've done everything I can to help this. So my questions - is the cost greatly improved by going overseas? If I can find a supportive PCP? I teach school and I know I can afford the supplementation, but two in college, supplementation, and a $30000 or $40000 in debt would be challenging. If by some chance my comorbid conditions do qualify me for insurance, did you all have to do the physician supervised weight loss first? Would Weight Watchers count? There isn't a hospital program within an hour of home and it would be challenging to say the least to find time to work out that far away from home. Thanks in advance. I surely hope you can find a way to make the DS happen---with Type II diabetes and those cholesterol numbers, the DS would most definitely be THE WLS for you. My cholesterol has gone from 230 to 112, and that's with me eating all the bacon I can afford... |
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Post by georgiagirl on Dec 28, 2011 21:59:36 GMT -5
Ooookaay - I'm almost sure at some point I read no paying for WLS, but I just reviewed all the online stuff, which included a survey for WLS. So maybe there is a possibility . . .Couldn't find any information at all as a matter of fact. If by some chance my insurance will pay, does anyone know anything about Dr. Bob Sass? He practices in Chattanooga.
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. I exercise and eat low carb and know I can maintain those as a life-long habit. I am pretty sure my insurance doesn't cover WLS. I haven't called, but I'm pretty sure I remember that. My mom, who struggled her whole life with her weight and typeII died suddenly in her sleep last year of a heart attack, my dad has had two heart attacks, and I want to know I've done everything I can to help this. 
