Please Help I am Confused ,,, VBG TO BYPASS

[Mark]

"I am a Self Pay so there is No Insurance will cover this."

What is your current insurance situation, exactly? You are in California, and my understanding is that the Covered California plans are regulated by the CA Dept. of Managed Health Care, which are very DS-friendly, so long as there isn't a contractual exclusion. If you are eligible for a Covered CA plan, you MIGHT want to consider switching to one of them - open enrollment for Covered CA goes until Feb 15th. However, you MUST look at the plans to see whether bariatric surgery is covered, which I'm not sure about, or - and this depends on whether you are having symptoms such as frequent vomiting - you may have a situation that requires surgery to correct complications, even though bariatric surgery is generally not covered.

Hello DianaCox,
my insurance is not going to cover since it's through medical , I am Looking to find an Individual plan through Anthem Blue Cross , but the problem I am not so well dealing with that and i really appreciate if you can help me how i can get insurance covers barbaric surgery and to make sure that Dr. Ara K on there network?
thanks
Mark

 

[Mark]

Hi @Mark, welcome. I also had the mesh as my surgery was in 1988. Ungson will revise the silicone VBG but not the mesh like us. Since you are in California, Rabkin and Kesheshian are great surgeons, but if you can't afford their price and can't use insurance (see if Diana Cox above can help you - she's wonderful at getting insurance companies to help when they don't want to) Greenbaum in NJ has a great self-pay price.
It sounds like you might have blown part or all your staple line if you're not feeling any restriction. Even if you hadn't, as Larra said, the VBG is one of the WORST surgeries around. It creates the owner of it to maladaptively eat (eating mostly soft foods) so they avoid blockages/don't throw up. Some studies have shown that it slows down the metabolism. IT IS NOT YOUR FAULT. The surgery has failed you, not vice versa. I'm actually surprised that it was still in use in 2005, and using mesh at that time.
Until I started researching revision surgery, I had this dirty little secret for years (26 to be exact) thinking that *I* was the failure.
I wish you good luck on this journey. I have a post where I detailed the best revision surgeon's prices - http://bariatricfacts.org/threads/vbg-to-ds-revision-s-surgeon-decisions.1576/

Hi jillc,I went through your post it seems to be a long journey seracing for Dr. Hero to do the revision, i am so happy that finally you find a good surgeon to do the revision, i liked your insist to go for the ds and nothing else, cause i am was about to agree to do the bypass until i went through your thread and what i heard about the bypass is not the best operation specially for the patine who went through a failed WLS before , How you doing right Now? wish you feeling better!

 

[Barb1]

@DianaCox Mark wants to see if you can help him. He didn't know to do the @DianaCox thing so @Mark that's how it's done if you want her to see it!

Edit to say
I hope all goes well for you! Dr. K is fantastic. Check out his web-site and blog. You will learn so much here and from him! Good luck!

 

[DianaCox]

If you mean you have Medi-Cal, why do you think they won't cover a revision? Have you tried to get the revision? Who did you see? What are your MEDICAL symptoms, besides weight regain? You are MO again, maybe even SMO.

There is a tiered plan in CA of care for people who don't have employer-paid medical insurance - if you are VERY poor, below about $14,800 (depending on where you live), you are on Medi-Cal, with no premium payments. If you are between that income and a significantly higher amount, you may qualify for one of the ACA plans, with a sliding scale monthly premium tax offset. Above that upper income, there are plans you can buy as an individual that are similar, and have no exclusions for pre-existing conditions.

With regard to Covered CA, you can CALL each of the insurance companies or an approved agent listed on the Covered CA website to get help identifying a plan that is suitable for you - assuming you qualify for Covered CA. You can ask them if DrK is covered under any of them. Or you can call DrK's office and ask them whether they take any Covered CA plans (might be easier).

I am currently helping my daughter figure out which plan is best for her (she has particular medical issues and wants to keep her current providers). We are going over the EoCs for several high-end plans (because she NEEDS that coverage, and I'll help her get it), and it has taken a couple of weeks to get the companies to cough up these documents (Evidence of Coverage - the complete contract that gives all the details about inclusions and exclusions).

What I CAN tell you from what I've seen so far from the EoCs that I have:

Anthem Platinum 90 D HMO: Covers bariatric surgery
Anthem PPO (not Covered CA): also covers bariatric surgery
Both Anthem plans have requirements for Centers for Excellence hospitals, depending on where in CA you live (mostly in SoCal).

The Blue Shield plans have similar language.

Still waiting for HealthNet to provide me with readable versions of their EoCs.

 

[robs477]

Hi Mark, good luck to you. You are VERY lucky already, having gotten on this site and gained access to these experts! You will have to do the legwork though, but they will absolutely put you on the path you need to be on, again wishing you more good luck. Rob