Insurance Approval / Financing - ThinnerTimes

nicekitty · 02-08-2005, 12:53 PM

Hello, all.

I am new to this site and I have a few questions about how the approval process works and, if private financing is required, what the approximate costs are.

Kaiser Permanente is my HMO and I have heard that it's notorious for not covering any of the costs associated with WLS. Are there any other Kaiser folks out there and, if so, have you any words of wisdom for me on dealing with this behemoth?

One thing that will work against me is that while I am considered morbidly obese by the BMI standards (5' 5" female / 255 lbs), I do not have any co-morbitidies. I am pretty darn healthy, actually. Except of course for my weight! And I have tried diets, behavioral changes, exercise, pills--you name it. And they all work. For a while. But the weight just comes back and usually with a vengeance!

I am 33 years old, but have no energy whatsoever. My weight gain has spiralled into a vicious cycle of inactivity and ever more weight gain. I don't want to wait for the parade of diseases to start: diabetes, heart disease, high blood pressure. I'm really scared.

I am also willing and able to finance this on my own if I take a second on my home. How expensive is the surgery?

If anyone out there has a few moments to guide me, please do so.

Humbly,

Marta

bridgetgirl · 02-08-2005, 01:08 PM

Very good questions! First of all let me say WELCOME TO THIS FABULOUS BOARD!

I checked into Kaiser and to the best of my knowledge they did cover the surgery, at least a few years ago they did.

Reagrding your comorbidities: you have 'em, you just dont know you do. I didnt think I did either but when you go to your surgeon and they ask a bunch of questions of you, you will be amazed at what ya got that you DIDNT know you had. Fatigue, headaches, arthritis, back pain, aching joints, joint instability, asthma, you may not have diabetes but you may have elevated blood sugars, urinary incontinece... little splashes when you run or cough or laugh... I could go on and on, this is just a smidgen of the co morbiditeis I ddnt think I had either. Granite i didnt have full blown diabetes, sleep apnea, etc there are other things out there that can make you a candidate.

Yes you can finance your own surgery, I know of a gal that took a second mortgage out on her home to have it done, as well as another gal that had the money to do it... she was less 75 pounds overweight and tired of the battle of the buldge.

If you dont get any additional feedback regarding financing options (there are medical finance companies out there also) may I suggest going to obesityhelp.com and going into the California forum and poting there... your subject could read ANYONE PAY CASH/FINANCE YOUR SURGERY? Im sure you will get feedabck there on that matter as well. It's good to have you here, let us know what you are able to find out so we may share that knowledge with others as well. Best wishes sugar pea!

watergirl · 02-08-2005, 02:22 PM

3 years ago, when I researched paying out of my pocket, expenses were in the range of $35K to $45K. That did not include labs, follow up, hospital stay, etc. That was just for the surgeon.

If you are not 100 pound plus over weight, most surgeons won't touch you.

Christina · 02-08-2005, 03:42 PM

Welcome to the forum first and foremost.

Secondly I do know someone who has Kaiser and is going through the process of trying to get approved for surgery. The thing with Kaiser is from what I have been told that you must go through a pre-approval process with them before they will authorize the surgery. I think that includes six months of doing their diet stuff. I am not quite sure exactly what that entails.. I am sorry.

If you were to finance the surgery I think it runs anywhere from 20 - 40 grand for surgical and hospital charges, however if God forbid you have a complication, it could cost upwards of 100 thousand or more. However, on a good note, most insurance companies DO cover any charges that arrise due to complications from an elective surgery. Therefore you may only be responsible for the 20 - 40 thousand??

I would go the Kaiser route first if you can. I know it sucks waiting another 6 months or so.. but trust me there are plenty of people who waited much longer and fought very hard for their surgery.

You can do it!!! Persistance pays off.. good luck my friend..

nicekitty · 02-08-2005, 05:03 PM

Thank you all for your thorough responses and warm welcomes. I started doing my research a little whand this is one of the best forums I’ve come across and the only one I’ve joined. It’s so well organized and the members seem to genuinely care for one another. That’s awesome…and rare.

I will definitely be contacting my members’ benefits people at Kaiser and asking about whether or not Kaiser covers this and what hoops, exactly, I need to jump through. I actually am over 100 lbs overweight so that won't be an issue and I have a BMI of 43. Yikes!

Funny what Bridgetgirl said about the co-morbidities—I guess I do have them, especially fatigue. And the shortness-of-breath thing . And I guess my knees don’t feel as great as they could…the signs are there for more trouble in the future. I feel I have more ammunition now when my doctor starts asking me why I want to undergo WLS (if I can ever get in to see him!)

I told my two dearest friends about my decision today and they were both appalled, even though I opened the conversation by saying, “Look, ladies, this is open for discussion but the conclusion is already forgone”. They’re afraid that this will change the way we celebrate—around food usually. I don’t care too much about losing my obsessive relationship with food. It’s been an ultimately unsatisfying love affair—oh, but alcohol. A good microbrew rates higher than a steak to me. I love a gin and tonic, too, on a hot summer night! I know it’s 5:00 pm somewhere!

Thanks, again, for all your great information reference. I haven’t checked everything out yet because I have been away from my desk, but I will. You’re all very dear. Perhaps I will learn more about your stories…

One last question—for today anyway—why do people still post even after WLS?

Marta

Dara · 02-08-2005, 05:19 PM

Quote:

Originally Posted by nicekitty

One last question—for today anyway—why do people still post even after WLS?

Marta:

Why do we post after WLS?

Because we can relate...because we get tremendously helpful information...because we share a common bond that only the other people here share...because we don't feel alone or afraid...because there's always someone who's been there or done that...because we feel loved here...because we can share our knowledge with people starting their journey after us...because we can help others...

Gosh, there's a thousand different reasons why. I'm sure my fellow postees can think of other reasons.

I have my biological family and I have everyone here...my WLS family. Families care about one another. That's why I'm here.

Christina · 02-09-2005, 08:57 AM

That is a great question..

Why do we post after WLS??

Let see.. if we didn't post after WLS who would be here to answer questions for the pre-ops or newly post-ops? For me, there were so many people who helped me along in my journey to know what to expect the days and weeks after WLS that I felt I wanted to and needed to do the same for others. Not only that I have met so many people here who have made my life so much better.. I can't talk to them on a daily basis, and these people are like my "sisters & Brothers" I love them so much I couldn't bear leaving this forum or them behind..

There are 4 people on this board.. who will be bridesmaids at my wedding.. Oh I wish I could have more because there are just so many people here that I love dearly!! However, I just have such a big wedding party as it is, I just couldn't get one more person to stand up for me..

In a nut shell, I need these people, and they need me.. that's why I am here..

Meaghan · 02-09-2005, 10:55 PM

Make sure you find out first if surgical procedures are NOT an exclusion on your policy... I was told 7 times that it would be approved, then was told it was an exclusion. My father (I thank God for him daily!!!) offered to cover my surgery - total cost $23K plus $1K for pre-op tests that will be filed to my insurance. It's crazy how expensive it is, but if I come out half as well as the rest of you - it's so worth it!

bridgetgirl · 02-10-2005, 05:29 AM

Nicekitty: I plan on posting until arthritic in the hands. Support is the # 1 key to successful weightloss and keeping it off. Support has gottenme through some pretty rough times... times when I just didnt know what to do with myself. The truth is, we all pretty know what got you MO in the first place, we have been there too. We know, without actually knowing you personally, who was abusive to you, who treated you unkindly, who was biased about you the minute they saw you... we all share this common bond, and the things that got us MO in the first place NEVER GO AWAY. Thinner does not make life easier... its a nicer place to be, believe me, however it doesnt take away all the ugly. Some of the ugly is within you. The folks here can see it, they recognize it, again without even knowing someone personally, and they will ALWAYS extend a helping hand to you. ALWAYS.

Some of my bestest friends in the whole world I have met through this WLS ordeal, I am double blessed to have regained my health (the body of a teenager) and fabulous friends who just get me. I hope you stick around and get as much in return as I have. We have a saying around here, on why we stick around... pay it forward! Good luck friend.

MystikMoon · 02-13-2005, 01:25 AM

I live in Oregon and also have Kaiser (well, I DID have Kaiser and am working on getting it back). Anyway, I haven't talked to them yet but I plan on calling them tomorrow and asking them about certain qualifications and such. Hopefully I can get started on their ridiculous diet and get it over with.