Hello, I'm Jordan

[Jordanwv216]

Hello, I'm Jordan and I'm trying to look at all my options for wls. I'd love to go through my insurance (PEIA, the same one from the West Virginia teacher strike). I first have to go through a 1 year weight management program and lose 10% of my body weight (~40 lbs) then I can start the process of applying for surgery. My first choice is the duodenal switch, with my backup choice being the sleeve. I've heard my insurance is the most difficult in my area to get approved through so I'm worried the 1 year wait will end in denial.

Or I can bypass the 1 year and try to go to Mexico for the DS.

Anyway, I'm here to learn more about the whole process and figure out what's best for me.

 

[harrietvane]

Or I can bypass the 1 year and try to go to Mexico for the DS.

If you can afford it, do that. My only regret about the DS is that I didn't do it sooner. A year if your life is no small part!

 

[Jordanwv216]

If you can afford it, do that. My only regret about the DS is that I didn't do it sooner. A year if your life is no small part!

That's kind of what my mentality is right now. Did you go to Mexico? If so, may I ask who your surgeon was?

 

[galaxygrrl]

I went to MX. Dr Equerra was my Dr. We have lots of his patients here. He is the only one I woul do the DS with. There are other Drs, but Dr. Equerra is vetted his patients and our DS experts on this board. Here is the website. http://www.mexicalibariatric.com/

Ask questions. I thought MX was crazy, but it was not and so glad I said screw it, I'm just going to do this.

 

[Jordanwv216]

I went to MX. Dr Equerra was my Dr. We have lots of his patients here. He is the only one I woul do the DS with. There are other Drs, but Dr. Equerra is vetted his patients and our DS experts on this board. Here is the website. http://www.mexicalibariatric.com/

Ask questions. I thought MX was crazy, but it was not and so glad I said screw it, I'm just going to do this.

The only thing is Mexico seems like a good option but when it's getting to be in the 10 grand ballpark I wonder if I should just wait and see if my insurance comes through a year from now. I would have to finance the majority of the procedure with it be that much higher than something like the sleeve in MX.

 

[southernlady]

Welcome Jordanwv216

 

[harrietvane]

I went to Canada, but everyone here raves about Dr Esquerra.

 

[galaxygrrl]

I know it's a lot of money for sure. Ask yourself about the money vs. a year of being skinny. It's a tough one for sure. I asked myself that question.

I still can't believe insurance companies make is so hard to get this procedure done.

 

[Larra]

Hi and welcome! Keep in mind that even if you qualify after a year, that doesn't mean your insurance covers the DS (maybe just other procedures) or that you can go out of state, and I don't know of any DS surgeons in West VA. So see if you can learn more details about your coverage, and if you are going to run into more barriers than even the one year wait (which is ridiculous all by itself), going to Mexico sooner rather than later makes sense.

 

[RainCity]

Jordanw: After a year of the weight managent program, then you can start the process for applying for bariatric surgery? How long will that take; another 6 months, and then you could still be denied? That’s tough. I recommend you start saving for surgery so if you get denied it won’t be a long period of time before you have the funds for self-pay. And if you get insurance to pay for your surgery then you’ll have a nest egg for something else (e.g. plastic surgery).

 

[DianaCox]

You can also try to challenge the requirement for a 12 month diet/10% weight loss, with our help (can't guarantee that it will work, but it might):

https://asmbs.org/resources/preoperative-supervised-weight-loss-requirements

There are no data from any randomized controlled trial, large prospective study or meta-analysis to support the practice of insurance mandated preoperative weight loss. The discriminatory, arbitrary and scientifically unfounded practice of insurance mandated preoperative weight loss, contributes to patient attrition, causes unnecessary delay of lifesaving treatment, leads to the progression of life-threatening co-morbid conditions, is unethical, and should be abandoned.
​

You would file a request for a waiver of the requirement, along with a letter of medical necessity from your surgeon or doctor saying that the delay has no medical justification, and would in fact likely cause you serious harm by continuing damage from X, Y and Z.

 

[hilary1617]

Hi and welcome RainCity ! Best wishes on your surgery journey!

 

[JackieOnLine]

Hi Jordan and welcome

it's stupid insurance makes you wait a year (for no good reason) and even then you don't know if they will cover you.

 

[RainCity]

Hi and welcome RainCity ! Best wishes on your surgery journey!

Thank you. I had MGB surgery in Mexico 11.5 months ago, am below goal weight, and am now trying not to lose anymore. I feel great and all of my comorbidities have resolved. I appreciate the expertise of the vets on this site and learn a lot from all contributors every day.

 

[Jordanwv216]

Hi and welcome! Keep in mind that even if you qualify after a year, that doesn't mean your insurance covers the DS (maybe just other procedures) or that you can go out of state, and I don't know of any DS surgeons in West VA. So see if you can learn more details about your coverage, and if you are going to run into more barriers than even the one year wait (which is ridiculous all by itself), going to Mexico sooner rather than later makes sense.

From my research Dr. Nease at Cabell Huntington Hopsital performs the traditional DS. It's about an hour drive for me. Also I believe there may be some doctors in northern WV around WVU but since that's about 2.5 hrs I haven't researched them too much.

I went to see my PCP this week and he said as long as I follow the monthly check-in reqs it shouldn't be too difficult. He recently went through the process for another patient. But he did admit that PEIA was a nightmare in general, not just bariatrics.