Planning & Possible Insurance Issues

[Meep]

I need to look at doing surgery after February. I hate waiting, however I have big clinical licensure exams right now. I have the option to (possibly) use 9 weeks of disability leave (we get paid at 67% from disability insurance and then our PTO pays the rest of the amount). I have like...150 hours of PTO. No, I apparently don't have a life. At any rate, is the full 9 weeks overkill for a VSG revision? I think it might be good for psychological reasons, physical healing aside. Thoughts? I am fortunate to have this so I was thinking I may as well use it.

My other concern is that today I reread my evidence of coverage like a bloody hawk after seeing many people post about it. Here are the requirements in case anyone is curious about BCBS IL HMO stuff. (Interestingly enough it would not have covered the revision to the bypass for GERD, either.) At any rate, the old policy allowed second stage procedures. The new insurance that I currently have only allows for a revision if the sleeve has a mechanical error. Does this mean they won't cover it at all? I'm hesitant to call my insurance and ask.

Thank you all in advance.

 

[DSRIGGS]

If a mechanical/health issue from the sleeve can't be documented it sounds like a tough situation. You are going to have to check with insurance at some point so I would highly recommend it now. Things don't happen overnight and chances are even if they approve they will require a physician supetvised diet of 3-6 months. I have no incredible BCBS PPO in IL (that means nothing because all plans,are different )and I had to do a 6 month diet. I decided in September of 2012 to get the DS and I thought I could get it done at our holiday shut down. Wrong! It was September of 13 by time I jumped through all the damn hoops. This one reason why many people self pay in Mexicali or here in states as you can get it done within a couple months.

 

[Meep]

I actually had the VSG done in three months with no pre-op diet. The wait time for pulmonary clearance near Chicago was ridiculous at the time...I waited 1.5 months for one test and then another month for the cardiac. I had BCBS IL PPO through work at the time and it was incredible. Sadly, work switched to an HMO with stricter (but still very lose by comparison for most) requirements. I'll ask Headley's office about it, since we've started documenting the stuff for plastic surgery in the next 2 years. I haven't left my job yet post-grad because the insurance is too good to give up, heh.

I have reservations about going to Mexico - not because of their end (many areas of Mexico have actually very good surgeons of all sorts not just WLS) but because I have a lot of co-morbid health conditions that can cause surgical complications. I also have time to decide, fortunately, and can work around it. If I can't get it state side, I may have to do Mexico, as once I start working full time as a therapist I will have to independently buy insurance (as an independent contractor) and who knows what the WLS benefits will be.

 

[galaxygrrl]

If Mexico is at all an option that might work for you economically, ask us questions. I had Diabetes (blood sugar was 300 when I went under) and some others comorbidites. It was all fine.

Also, remember, you do get COBRA for 18 months, so you can keep your insurance for some time.

I wrote a lot about Mexico on this page of this thread. - http://bariatricfacts.org/threads/march-2017-target-date.4858/page-3 if you want to read it.

 

[Svetlana Leigh]

I don't know about the insurance but I used FMLA. I hold a status of salaried exempt so I didn't have to use PTO for the first 30 days and I still got paid which was pretty cool. I didn't realize it until I returned back to work. I took a total of 5 weeks off so I used one week of PTO. Had I known, I would have taken more time off but not because I was in any pain or anything. Like you, I have a ton of vacation time. I could have went back after 3 weeks but I wanted to get my bathroom habits under control. Physically, I felt great. Everyone is different though. Some people take 6-12 weeks off. If you have the time then I would at least utilize 4-6 weeks if you can.

I was a band revision to the DS.

 

[DSRIGGS]

I don't know about the insurance but I used FMLA. I hold a status of salaried exempt so I didn't have to use PTO for the first 30 days and I still got paid which was pretty cool. I didn't realize it until I returned back to work. I took a total of 5 weeks off so I used one week of PTO. Had I known, I would have taken more time off but not because I was in any pain or anything. Like you, I have a ton of vacation time. I could have went back after 3 weeks but I wanted to get my bathroom habits under control. Physically, I felt great. Everyone is different though. Some people take 6-12 weeks off. If you have the time then I would at least utilize 4-6 weeks if you can.

I was a band revision to the DS.

My job had 8 weeks of salary continuation and then it kicked over to short term disability if you needed more time off...and yes FMLA was in force to protect although I found out about my position being eliminated when I was out for my revision surgery. I knew the bastards would do it to me since with benefits and my salary/bonus they could pay for 3-4 professional in India to take my job....which they did. Lesson to be learned, make sure youfuck up at work and don't set up a global program that was on autopilot to hit target this year (They thought it was would take 3 more years) or they bend you over and don't even kiss while they are slamming you!

 

[Svetlana Leigh]

My job had 8 weeks of salary continuation and then it kicked over to short term disability if you needed more time off...and yes FMLA was in force to protect although I found out about my position being eliminated when I was out for my revision surgery. I knew the bastards would do it to me since with benefits and my salary/bonus they could pay for 3-4 professional in India to take my job....which they did. Lesson to be learned, make sure youfuck up at work and don't set up a global program that was on autopilot to hit target this year (They thought it was would take 3 more years) or they bend you over and don't even kiss while they are slamming you!

Oh wow that sucks!! I hate they did that to you. Totally not cool. We're just a number to our employer and nothing more...

 

[Meep]

Thanks!

11,000 for surgery is actually very inexpensive, out of pocket. I have four autoimmune disorders and four prior abdominal surgeries (two were emergency) with huge incisions, and also a history of surgical MRSA. My doctors often joke I have a half a million dollar abdomen, heh. But, they make surgery tricky. I'll definitely still check out Mexico.

I forgot about COBRA. It will still be a while before I go independent contractor. The insurance blip puts a kink in it anyway - if it's even a kink. Going to check with the bariatrician and U of C, of course.

I wish Headley did the DS. Eventually, hopefully Edwards-Elmhurst will be another strong option after the next 5-10 years. They have excellent staff and surgeons already familiar with it, since many were trained at U of C.

 

[Meep]

My job had 8 weeks of salary continuation and then it kicked over to short term disability if you needed more time off...and yes FMLA was in force to protect although I found out about my position being eliminated when I was out for my revision surgery. I knew the bastards would do it to me since with benefits and my salary/bonus they could pay for 3-4 professional in India to take my job....which they did. Lesson to be learned, make sure youfuck up at work and don't set up a global program that was on autopilot to hit target this year (They thought it was would take 3 more years) or they bend you over and don't even kiss while they are slamming you!

I'm so sorry that happened. I hate suing, but I'd have sued over that. That's actually illegal.

Thankfully, I have a clinical license. (I'm a therapist.) I am already starting to network and get independent work even though it is two years until I get my hours for being on insurance panels independently. I'm working on getting into a practice. There are no shortage of jobs in my field, though the best ones are highly competitive in Chicago since we have the highest number of psychology schools per capita here in the nation (18 PhD programs alone!)

I will be teaching in the next 6-12 months part time, doing independent bariatric assessments and post-op counseling, and may just drop to 30 hours at my current job to keep my insurance for now, depending on how things change.

 

[DSRIGGS]

I'm so sorry that happened. I hate suing, but I'd have sued over that. That's actually illegal.

Thankfully, I have a clinical license. (I'm a therapist.) I am already starting to network and get independent work even though it is two years until I get my hours for being on insurance panels independently. I'm working on getting into a practice. There are no shortage of jobs in my field, though the best ones are highly competitive in Chicago since we have the highest number of psychology schools per capita here in the nation (18 PhD programs alone!)

I will be teaching in the next 6-12 months part time, doing independent bariatric assessments and post-op counseling, and may just drop to 30 hours at my current job to keep my insurance for now, depending on how things change.

I was given notice that upon my return to work for CAT that I had four months to find a job internally. Well our VP jumped the gun before others and because 10,000 people were gething axed they actually gave us a month after I was back. That also screwed me out a half months pay and full cesting of my 401-k because it would have been mid January and my 3 year anniversary and vesting date was jan, 3. That cost me $20k on 401-k and half a months salary. I got 4 months severance but it didn't extend my work date as it was lump sum and termination on 10/31.

Sucks all the way around but I would not have won the suit and I needed the severance money which I wouldn't have gotten if I didn't sign the agreement. even if I could have won they would have tied it up for years

I have a friend who is a director in another group and he was trying to get me into his team but when the lay offs started a hiring freeze happened as well. Even at his level he couldn't do anything. Sucks to have an MBA and 25 years of senior levlel management experience but it was an industry outside of Cats and I didn't have enough time to build the internal network because it is an old boys club if you were in...but a 50 year old dude loses out to young more diverse demographic groups if you can't cracking into that club.. They saved a couple hundred thousand annually on me when you count benefits, so I was a fat target (no pun intended) who had no chance because nobody was protecting me.

 

[DSRIGGS]

BTW I wouldn't mind teaching at a community college or university that wasn't a research mill where you needed a PhD and to be published. unfortunately with me back to being dizzy, weak and passing out again, work of any sort isn't happening. I haven't been able to work since February because I can't drive with me paswing out, not to mention I would get fired because u have no energy to do any work now. I am desperate and getting depressed about my future.

 

[Meep]

BTW I wouldn't mind teaching at a community college or university that wasn't a research mill where you needed a PhD and to be published. unfortunately with me back to being dizzy, weak and passing out again, work of any sort isn't happening. I haven't been able to work since February because I can't drive with me paswing out, not to mention I would get fired because u have no energy to do any work now. I am desperate and getting depressed about my future.

I'm so sorry you have been through all that, Scott. My father has an MBA from Rutgers. I'm familiar with what you are describing regarding work.

Many schools closer to Chicago will actually hire you with just a masters and no publications. Check private universities to see if they will hire you. Lewis University and Aurora University are two. They are far from you, but they also hire for online classes so you could live where you do and not have to worry about driving. One class isn't too bad to teach. I don't have a PhD and I still have teaching opportunities. There are probably a lot where you are too. They just do not advertise they are available, sometimes.

 

[galaxygrrl]

Thanks!

11,000 for surgery is actually very inexpensive, out of pocket. I have four autoimmune disorders and four prior abdominal surgeries (two were emergency) with huge incisions, and also a history of surgical MRSA. My doctors often joke I have a half a million dollar abdomen, heh. But, they make surgery tricky. I'll definitely still check out Mexico.

I forgot about COBRA. It will still be a while before I go independent contractor. The insurance blip puts a kink in it anyway - if it's even a kink. Going to check with the bariatrician and U of C, of course.

I wish Headley did the DS. Eventually, hopefully Edwards-Elmhurst will be another strong option after the next 5-10 years. They have excellent staff and surgeons already familiar with it, since many were trained at U of C.

Look, I hope you don't have to go to Mexico, but Dr. Esquerra is very good and he does really is more than w WLS doctor. He was doing hernina repairs and a bunch of other non DS stuff when I was there, so he could be an option.

 

[Susan in Tennessee]

Look, I hope you don't have to go to Mexico, but Dr. Esquerra is very good and he does really is more than w WLS doctor. He was doing hernina repairs and a bunch of other non DS stuff when I was there, so he could be an option.

If I remember correctly his original specialty is trauma medicine.

 

[Meep]

Look, I hope you don't have to go to Mexico, but Dr. Esquerra is very good and he does really is more than w WLS doctor. He was doing hernina repairs and a bunch of other non DS stuff when I was there, so he could be an option.

Oh sure! There are actually many good doctors in Mexico (and other countries). I've never sent clients to Dr. Esquerra, but I often help transgendered clients work with and see surgeons in Mexico. Some of the most skilled gender transition doctors are there. It's a misnomer that the care is worse. The standards of surgery are sometimes even higher overseas than they are in the US.

I appreciate it very much. It's absolutely great to have options I am also glad to know because I definitely will give the info to clients, too.