Going with the Sleeve, Have a Date! - ThinnerTimes

OsoDelDesierto · 01-04-2008, 10:01 AM

February 13, 2008!

As some of you know, I have made the decision that the Vertical Sleeve Gastrectomy ("VSG" or "the Sleeve") is the right choice for my WLS, even though my original path on this journey was going to be RNY. My surgeon, Dr. Patrick Chiasson, submitted me for approval with special documentation on the VSG and why it was the appropriate surgery for me instead of RNY, but PacifiCare denied the surgery (big surprise

) because it still considers the Sleeve "experimental" and my policy only covers the RNY. My surgeon did a "peer-to-peer review" with the Medical Director of PacifiCare of Arizona after the denial, but with no success. I can go through a formal appeal, but don't have a great shot at winning, given the exclusion in my policy, and don't want to delay my journey any longer.

I am going self-pay, biting the "home equity loan" bullet and financing the surgery through my mortgage lender. The loan closes tomorrow and will fund next week, and then I get to start writing checks.

The surgery expenses will be tax deductible for 2008 and the interest on the home equity loan may also be deductible, so I will get at least some of the money back. In addition, I will try to appeal the denial by PacifiCare to see whether I can get insurance to cover at least part of the WLS...

I have a pre-op teaching class and meeting with my surgeon scheduled for January 24 and will do my lab tests on February 11. I'm not as excited this time as I was back in June when I got approved for RNY with Dr. Schwartz (bless his heart), but I'm still very pleased to be moving forward on the journey.

I will keep you all posted as to my experiences. Since Teenieleenie has been pretty quiet on this Forum these last couple of months, I may be the only Sleeve TTer for a while, but I look forward to sharing my journey with all of you! Oh, and since my "Leo" surgery was cancelled last summer, I guess I will be reborn as an "Aquarius" instead - this is the dawning of the Age of Aquarius, Aquarius, Aquarius!

Robin W · 01-04-2008, 10:06 AM

That surgery date sure was a long time coming. Congratulations! Though I'm sorry to learn you've had to go the self-pay way. Huge bummer there but I'm sure you'll feel it is totally worth every copper penny in the long run.

fisher1000 · 01-04-2008, 10:08 AM

Congrats, Eric!

Woo! Woo! Woo!

-Mike

Toony · 01-04-2008, 10:09 AM

You have a DATE!!! WHooOoOooOOO!

Sorry you have to self pay, but I know you've thought long and hard on this and are willing to make the sacrifice. I met a Lap Band gal at a support group meeting who was self-pay... $12,000 and she got $6,000 back in taxes... I know your surgery will be more, but hopefully you'll see a healthy refund on you '08 taxes.

I'm excited to learn how the SLEEVE works for you ... given your circumstances, I'm sure this is the right choice! You're just ahead of your time - as the sleeve makes leaps and bounds into the ring called "Gold Standard!"

We're almost MATCHING dates Eric! I'd better get working on your sock sea monkey... a cuddly pal for the hospital!!!

HUGS and more hugs to you today!

Katie

kittens4 · 01-04-2008, 11:55 AM

Congrats! Sorry you have to fork out the cash yourself, but sounds like it'll all work out just fine. Your health comes first! It'll be a lot easier to work off that loan when you are slimmer, healthier, and happier!!!

I am anxious to hear about this sleeve business...I'm going online to look up some info on it. I've never heard of it before...but sounds like you've researched it and decided it's best for you. Glad you are moving forward.

kittens4 · 01-04-2008, 11:59 AM

Well, I just checked it out, incase anyone else is curious, here's a little bit of info on it. Actually it sounds pretty cool.

I'm excited for you!
This procedure generates weight loss solely through gastric restriction (reduced stomach volume). The stomach is restricted by stapling and dividing it vertically and removing more than 85% of it. This part of the procedure is not reversible. The stomach that remains is shaped like a very slim banana and measures from 1-5 ounces (30-150cc), depending on the surgeon performing the procedure. The nerves to the stomach and the outlet valve (pylorus) remain intact with the idea of preserving the functions of the stomach while drastically reducing the volume. By comparison, in a Roux-en-Y gastric bypass, the stomach is divided, not removed, and the pylorus is excluded. The Roux-en-Y gastric bypass stomach can be reconnected (reversed) if necessary. Note that there is no intestinal bypass with this procedure, only stomach reduction. The lack of an intestinal bypass avoids potentially costly, long term complications such as marginal ulcers, vitamin deficiencies and intestinal obstructions.

chiquita · 01-04-2008, 12:20 PM

Congrats,finally you have a date

I am also self paid. I ended up saving the first 10,000 cash, thinking I was going to have the lap bad put in, but the doctor talked to me and changed my mind. Now I had to come up with another 15,000, that would be a few more months of savings that I was not willing to wait for, affraid I get into the money for whatever, or that I would change my mind, gain wait, die, etc, etc, etc. So I got me a cosmetic surgery loan and got approved on the spot at a good interest rate so here I have 4 more days to go before I get ploped into the Losers bench

I know this one thing, even if I am self paid, and I never thought I would spend so much money just on me on something like this, I am paying every penny, writting every check knowing that is the right thing for me and I do it happily. After I am done paying for my loan. I will start saving for TT and Brest life lol, such is life

Hang in there

and keep us posted on your proceedure, I saw a show on TV about it and know is new proceedure so make sure to document us with all your milestones

janine · 01-04-2008, 12:27 PM

Eric, congrats!,
At last you have a date... I really thought you'd win the insurance fight but all is well! you've had alot of time to think about what kind of surgery you aught to have. It's been a long time coming... After all this time you have done so well. Have you gained to terribly much since the holiday? It's been a difficult road but the light at the end of the tunnel is shining bright. I've thought of you often and wandered what you would do.

good luck

Corrine · 01-04-2008, 01:47 PM

Eric,

I am absolutely delighted that you've now got a date but like the others, I'm sorry you've got to fund this yourself.

Sending you big hugs - I'll keep a place warm for you on the losers bench.

Godsblessedme · 01-04-2008, 02:23 PM

wow Eric your story is amazing. I too was denied first for the RNY and was going to self pay for the lapband, but within a week they approved my appeal for the RNY and i'm now 2 weeks post op. Dont give up with Pacificare keep appealing they may pay part or most of it

Congrats on your decision to go ahead with the sleeve. Worth every penny

I see your in Tucson is your doc here in phx?