Question:
confused and not sure which way to go.......
Ok this is my situation in a very shortened version.After trying for months to get approved by my insurance,I basically gave up on the fact that it was going to happen.They are changing the policy for WLS now that they are providing services at our Hospital.Kinda stinks that they covered it elsewhere before but now don't want to.Anyway,after being told for the last 4 months that everything was put on hold til the new policy was written,I kinda gave up and started on weight watchers for one last ditch effort.Today I get a call from the insurance company saying that they have decided to cover $10,000 flat(surg is approx $25,000 here)My thing is that,i'm afraid to get too far into debt by having to pay the other 50%,and part of me is wondering if I should just stick with Weight watchers and hope for the best.I am so confused,the only thing that I am sure of is that I want to get this weight off.I was afraid to post this on weight watchers for advice since most of them are anti-wls.......please someone give me some advice....... TIA, Kim — kim M. (posted on November 19, 2002)
November 19, 2002
Hi Kim! Boy, that is a tough desicion to make! Have you tried WW before? If
you haven't, it can't hurt to try! If you have been through WW before,
(like we all have!) then you know that it might not be the answer for you.
No one can make the desicion for you, you have to do what you REALLY want
to do. I know it's hard to decide, especially with that amount of money
involved. I had surgery on 8-7-02, and I have lost 75 pounds. So do I think
it is worth it? YES. But that is just me. If right now isn't a good time
for you to have surgery (for whatever reason), maybe it would be the best
for you to wait until you are sure. I hope everything works out for you.
:o)
— fropunka
November 19, 2002
Well, only you can answer this for yourself. But, look at it this way.
Would you spend that much on a new car? Renovating your house if you have
one? We don't think anything of plunking down a chunk of change and going
into debt for on an inanimate object but if its regarding our health, we
hesitate. What is wrong with that picture?!! Aren't you worth the
investment?! I should hope so! Look at all the money you have put into
every diet out there and add it up. I'm sure its a considerable amount. Why
'hope for the best' when this surgery is almost a guarantee if you use the
tool right.
I am at the point where I'm looking at Plastic Surgery. I will be self pay
for it and I'm looking at $18,630.00 for a TT, breastlift and arms done at
the same time. This is what I paid for on my car! I thought about it and
decided, yes, I'm worth it!! Good thing my husband thinks so too! I'm
taking out and equity loan for some of it and financing the rest thru a
company my PS surgeon uses. Good luck with your decision.
— Kris T.
November 19, 2002
Hi Kim...It's a shame that your ins. co (or is it policy) doesn't cover
more of the WLS costs. I am sure you have resarched all angles of that,
and are at an impasse. Anyway, I would encourage you to keep with WW as
best you can. I just rejoined and there was a lady there celebrating a
100lb weight loss - it took her a year almost to the day. Even if you
don't lose much, it may help you keep from gaining at least, until you can
get your WLS. Look into financing it, etc. if you can't find an angle with
another ins co or policy. Best of luck to you!
— rebeccamayhew
November 19, 2002
Ok, so I lied, said I wasn't gonna post here anymore, but I have to!!!
ASSUMING you decide to go through with the surgery, DO NOT go back to that
office and tell them, ya, let's do it...at $25k. Just like a few other
posters here said, you spend that much on a car, why not you. Well, do you
pay sticker for your car?? God I hope not,lol. If so, come see me, I
finance them, hehe. Call your doctor's office and find out who it is you
need to speak with to negotiate the price...usually it's your
surgeon-to-be. Tell them what the insurance is willing to pay. Tell them
you don't mind pitching in for SOME of the rest of it, but that you think
that it could be less than what it is at present. My wife had this
surgery. The bill sent to the ins co was for over 40k!! Take a guess how
much the surgeon got paid...1200. Granted the hospital and anastesiologist
(god i know that spelling has got to be wrong,lol)and a few others have
their fingers in the mix, but your surgeon can and will cut their price to
make it work for you. If they won't, they may not be the right doctor for
you anyway. Your surgeon should WANT you to be able to have the surgery
because it benefits YOU, not necessarily his checkbook. Good luck
— Kevin P.
November 19, 2002
I'm the original poster,thanx to everyone's replies.I have alot to think
about before I decide.2 months ago I was more then ready to have the
surgery,but I really want to be sure.
Thanx again,
Kim
— kim M.
November 19, 2002
Hi, Kim. You have gotten some great responses, I just wanted to add my two
cents worth. I think you are very courageous for thinking this through so
carefully and for giving WW another good solid try. I wish it would have
worked for me. I'm about 3 months post-op and would love to have been able
to achieve the same results with WW. I wish you all the luck in the world
- please keep coming back here for support - these are the greatest folks
in the world!! (I especially like the idea of negotiating your doctor's
fee!!)
— Scarlett A.
November 19, 2002
weight watchers is the only program that I hadn't tried in the past thats
why i decided to try it while I was waiting for a decision from my
Insurance Co.This is my 8th week on the program and have only lost 10
pounds,but it's better then gaining it :) I'll keep ya posted,and good
luck to everyone else in their journey's .....
— kim M.
November 19, 2002
Kevin is right- you should try and negotitate the price with your surgeon.
I had to self pay for my surgery. I received a "package deal"
that included the surgeon's fees, operating and recovery room fees, a 3 day
hospital stay, anesthesiologist fee, all pre-op testing, all follow-up
visits, and weight management aftercare services (nutritionist) for a year.
I paid $18,000. I received a detailed statement from the hospital showing
what would have been charged to the insurance company, approximately
$30,000.
— LLinderman
November 19, 2002
Thanx for the info,I wasn't aware that you were able to negotiate the price
of WLS.My insurance will only pay $10,000 on the surgery and that can't be
used towards pre-op testing and post-op complications,thats what really
makes me nervous,what if I just happen to be one of the few that has
complications,none of that will be covered.I'm leaning more towards going
ahead with the surgery,but I am scared to death with the financial
situation it could put me in.I would feel horrible if I was the reason that
my family had to suffer financially,even though I know that I both need and
deserve this surgery.Thanx for listening......
— kim M.
November 20, 2002
Did your insurance company say that they would not pay for any medical
expenses that could arise due to this surgery other than the 10k? If they
are not willing to cover anything that may be related I would definately
find a secondary policy for a while. I am queen of the complications and
had I not been insured it would have financially devistated my family. And
these complications did not come about until 6 mos post op. I would see if
you could get coverage thru a spouse or an individual policy for at least a
year following surgery. Its a little harder to negotiate medical fees on
an emergency procedure or a surgery that you may need right away.
— RebeccaP
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