amlus

I had pre-existing coverage like 90 days before this plan went into effect. Iowa's law is you cannot go over like 66 days or they can hammer you with a 12 month per-existing condition clause. :crying: It says in my health benefits document that "...You must have a Body Mass Index of at least 40 for at least three years..." I have none of the 5 major comorbidities they specifically count if your BMI is just greater than 35...yet. But, need a year of documentation even if I were to get one. Been tested for sleep apnea and don't have it. I guess I am thankful I don't have major comorbidities, but I am having back & knee issues and have a genetic history in family of Diabetes, both types. Thank you so much for your help and input! I think my insurance should pay for this and am very sad that they won't......any other ideas are welcomed!:thumbup:

Well, I have a 12 month pre-existing clause on my insurance so they denied me because of this. In my fifth month of having this policy now. Also, at they also want a three-year BMI of over 40 and I have been 38-39 and over 41 for just the last year. No major comorbidities......So, I can go self-pay or wait 1-2years MORE. I have already waited almost a year for this......thinking I will head to Colorado....SO BUMMED because I am ready for this NOW....

:cursing: Ummmm, I just called that # and spoke with Brandi and the cash pay price is $14,100, which includes one year of follow-up care & adjustments, NOT $5,700. Didn't think that made much sense.....

??? What the heck? The going rate around here is $12,000 - $16,000! There are a few places around $9,950 around Denver I have looked into. That really seems to low....are they like real doctors? (: Do they have you go to Mexico for the surgery?

What???? Was this the total self-pay cost? I am in Iowa. What Dr. and what facility?

I paid $1,700 (my insurance deductible) but no apnea here.

Yeah.....it does suck. Insurances are starting to make it more and more difficult to get the surgery approved.

Yep...I am in the same boat except denied by Blue Cross. I have a 12 month pre-existing clause on my insurance so they denied me because of this. In my fifth month of having this policy now. Also, at they also want a three-year BMI of over 40 and I have been 38-39 and over 41 for just the last year. No major comorbidities......So, I can go self-pay or wait 1-2years MORE. It really stinks. I feel your pain...:thumbdown:

Heh..your story sounds like mine! I am waiting on insurance approval ---but if it doesn't happen I will be self-pay and am considering Dr. Kirschenbaum if it goes that way because my local surgeon is like $16,000......Good luck!

Great thread guys! It helps us pre-bandsters to read this.....also I like it when you post what your original weight/BMI was and then pounds lost over what period of time. Thanks:thumbup:

So on my journey, I am a 41 BMI, just have flucuated over the last three years between 36 and 41. So, I have read in my policy that ins. wants to see above 40 BMI for three years. So, my doc (without even me suggesting) sends me in for a sleep study because I have "enlarged, huge tonsils", weight gain, headaches, tired all of the time, and snore loudly. Sometimes, I actually wake myself of snoring/choking. So , after I complete sleep study and technition tells me that she doen't think I have apnea but RESTLESS LEG SYNDROME and a weird R.E.M. disorder????? She says I had a little apnea but I mostly slep on my back, so that is to be expected! She I also said I fell asleep right away (which I did not and didn't seem to realize I had woken up at least 7 times in six hours.) Once I even woke up like on my own snore gasping. She said to wait 10 days for Pulminoligist to read results and write report, but that he usually agreed with her. Are you kidding me? I told my doc I had to pay the $1800 for the study completing out of my own pocket, so to be really sure and he was. He put me through other bloodwork like thyroid, low iron/anemia, etc. Doc said he was giving me all those tests to rule out, but was pretty sure I would end of doing sleep study and it would confirm apnea and my tonsils would have to come out! Plus, I would sure like to know how they monitered oxygen levels in my blood, because no blood was ever taken. Anybody ever had the heart specialist reading stuff the techs did not? Anyone else ever experience anything like like? I am really bummed about all of this. I was getting my hopes up that I might actually feel rested in the mornings with treatment, but I guess I still feel crappy with no answers and two grand less. Any advice or comments appreciated because I am feeling really down now.

Yep---I am in the same boat as you guys. 41 BMI for last couple of months, but up and down for the last couple of years. Keep us updated on what works and what doesn't. My insurance is Blue Cross Blue Shield, Alliance Select HSA.

Well, each insurance policy is different and this is what my Blue Cross Blue Shield wants to see. I'm just like you, fluctuated a little. I'll have to go further with surgeon/insurance and see what happens. Good Luck to you to! It's so backwards, insurance companies waiting until you are sooooooo unhealthy to finally cover this.

I haven't even started submitting lap band paperwork to my insurance, BlueCross Blue Shield but I have read that they wand the 40 BMI plus a three year history of 40 or more. My friend suggested a write about my family genetic disposition to diabetes (the rarer skinny people insulin resistant kind) both my parents, grandparents, aunt aunts have diabetes and/or heart disease.....and they are skinny! She also thought if I pull out my GERD and joint probs with my knee, I might have a slight chance with insurance yet. Anyone else ever get around the years of weight history thing? Thanks for the responses guys, I am pretty frustrated and sad about all of this...........

I have not done this yet, but have BlueCross Blue Shield Blue Priority HSA (in Iowa) and would also appreciate any info on this.

Hi, There is a chance I may have sleep apnea and the surgeon's office wants me to go to my local physician and get tested for it. I understand the sleep study at a clinic but have a few questions for those of you that have sleep apnea or went through the testing. First, my deductible is quite high so how much did the study cost? Was anyone just diagnosed by a home study or their own doctor? My husband actually woke me up at 3am last night and was like "you HAVE to go to a doctor! Something is seriously wrong with your snoring/snorting loud noises" So, I made an appt. with my local doc, but would appreciate if others would share about their experiences with this. Thanks!

It is really interesting to hear others speak of how wonderful they feel after getting treated for this......I'm all for feeling better!

Thanks for the comments guys! You know, my husband says that my snoring is sooooo loud and I am soooo tired all the time. My BMI is right around 40. I quit smoking a year ago and have gained like 20 pounds since then:mad2: If you told me to go to sleep at any time during the day----I could!

For those of you that were self-pay with Dr. Kirschenbaum (sp?) in Colorado......what was the agreement if there were any complications? Thanks!

Hi! I have been lurking here for many months and finally decided to say hello to all and thanks for a lot of the good information and encouraging words I've read on here. I will probably be self-pay because my insurance is new (self-employed) and I think they might have me on the pre-existing conditions clause. So, I am looking for any and all advice and recent COSTS on self-pay surgeons from the Midwest. :smile:Thanks in advance for any responses.............

Dr. K. is the route I am leaning....however I really hate flying! I am a big chicken and would prefer to drive. However, I am getting a huge variance in prices in the Iowa/Nebraska/Kansas area. I am getting anywhere from $14,000 to $20,000 for different surgeons. Keep us posted on your progress and whether you are satisfied with everything. Prices do seem to be dropping in some areas recently and I would appreciate any self-payers posting what/when/where they went and if they are satisfied or not......