Maggie225

I also need to lose 85 lbs. and I would be more than happy if that happened within a year. I have not been banded yet and I'm still concerned my insurance wont cover it. I'm 230 lbs 5'7" with a BMI of 36. I will be sending my packet of paperwork to the surgeon's office tomorrow, so hopefully I will get a consult and be eligible for the lap band surgery. I have been very thorough to dot all the I's and cross all the T's so hopefully this process wont take too long. Keep your fingers crossed for me :thumbup:

Thank you all for posting to this thread. After reading everyone's stories I feel much better. I am currently 5'7" and weigh 230 lbs which puts me at a BMI of 36, but for the past few years my weight has gone up and down and at times was under a BMI of 35, so I am extremely nervous that my insurance will not pay because I have gone below the 35. but now I think I might still be able to have this surgery in Mexico (at a reasonable price) if my insurance turns me down. You all give me hope, thanks again:smile2:

Thank you Mary. I feel better knowing Dr Rahman comes highly recommended. Let me know how your consultation goes with him. Good Luck:thumbup: I am about 1 1/2hrs away from Arnot. I'm still in the process of getting my PCP to do the paperwork. Thanks again for the reply

Thank you Band Groupie:smile: I am in Genesee PA which is at the very top of the state next to the NY border, I did call my Insurance and I am covered if I have a BMI of 35 with 2 co-morbidities(sp?) I'm not sure if I would have to do the 6 month diet or not. Was that required from your ins or surgeon? I did look into LB doctors in my area and there are 2 at Arnot Ogden Medical in Horseheads NY which is a about 1 1/2 hr drive for me (and both doctors and the hospital are in my insurance network) I have UHC ins. and from what I've read on the forums most of the people with UHC have to submit 6 weights (over the 35 BMI) for the last 2 years, which scares me because I have dieted so much that I'm not sure if my BMI was 35 at any of those office visits. Sometimes it feels like I take 1 step forward and 2 steps back:cursing: Thank you for your wonderful suggestions and support, I really do appreciate it. I will keep you all posted, because I am not giving up without a fight:rolleyes:

First of all I have to say to Band Groupie, I loved your blog. I have been doing the same thing you did, I have ate everything in sight for the last 2 weeks to get to the 35 BMI and I agree with you "its not fun when your trying to gain wait, I made myself sick a couple of times...LOL Anyways, I had my appointment yesterday and my Dr is sending me for more tests for my Diabetes, my OB/GYN has been monitoring it for the last year but has not put me on any meds and my PCP was a little upset that nothing more was done for me (he's a great guy and very knowledgable) so I guess I am going to have a 3 hr glucose test and a kidney function test done. My Dr did tell me that the medicine that he plans to put me on will help me lose weight but when I asked him how much, he laughed and said probably not as much as I wanted. I did discuss the lap band with him and he did comment on how much I had researched it, he said he wanted to focus on the diabetes first (which is understandable) and then we can see where my weight goes from there. I am certainly not giving up and I figure every visit to him gives me another documented weight on file, right?:tt2:

Thank you Jodi, your comment makes me feel much better. My appointment isn't until 4:30 today and as the time passes I seem to feel more relaxed. I really hope my Doc and Ins will both agree that this is a medically needed surgery:cool2:

(I posted this on another thread before I found this one) I have an appointment today with my PCP and I'm going to ask about getting the lap band. I am sooo afraid he will tell me I'm not fat enough.....it seems weird to me to say that because I have been overweight my ENTIRE life, but my BMI is just over 35. I have always weighed over 200lbs but again I'm afraid he will tell me I'm not a good candidate for the surgery I do have diabetes type II and PCOS and knee problems and I've also been on 4 different prescription meds for weight loss with no success. I guess I'm just posting this to try to relieve some of my anxiety because I really, really want this surgery. I would love to hear from anyone who has a BMI of 35 that has been banded and anyone else that wants to jump in here too:cool2:

I have an appointment today with my PCP and I'm going to ask about getting the lap band. I am sooo afraid he will tell me I'm not fat enough.....it seems weird to me to say that because I have been overweight my ENTIRE life, but my BMI is just over 35. I have always weighed over 200lbs but again I'm afraid he will tell me I'm not a good candidate for the surgery:confused: I do have diabetes type II and PCOS and knee problems and I've also been on 4 different prescription meds for weight loss with no success. I guess I'm just posting this to try to relieve some of my anxiety because I really, really want this surgery. I would love to hear from anyone who has a BMI of 35 that has been banded and anyone else that wants to jump in here too:cool2:

I went to the Lap-Band website and did a search for certified Lap Band doctors and found there are 2 at Arnot Ogden in Horseheads, NY I think I will go with Dr. Anishur Rahman the other doctor certified for the lap band was the Dr. I mentioned above Dr. Subramaniam Sadhasivam (boy thats a mouthfull :thumbup:) Well anyways I figured I would post them on here in case anyone else was looking for a certified Lap-Band doctor in this area:thumbup:

Hello:waytogo: and Welcome

I am checking into Lap-Band surgeons in my area and Arnot Ogden in Horseheads NY is the closest Hospital with a Doctor that does the band. The doctor is Dr. Subramaniam Sadhasivam and he is covered under my insurance UHC. I am going to look into some other doctors in the Buffalo NY area because I am about 2-2 1/2 hrs from there. Any suggestions???? Thanks "Revised" I also found 2 other Dr's at Arnot Ogden Dr Robert E Cole and Dr Douglas Mckane I did a search for Dr Moon but he apparently is no longer at Arnot Ogden

Blue Bug I would consider calling your insurance carrier to make sure the figure from the surgeon's office is correct (it sounds a little fishy to me) and if it is correct I would find another physician if I were you. Don't give up hope:rolleyes:

This is just my guess, but I would say that you should contact your BCBS and see if they have that 6 month grace period like bjornsyouruncle stated. Or if you have your insurance packet you could maybe read through there and see if they have a grace period???? Just my 2 cents, I hope you can get them to pay for it so you dont have to wait a whole year, that would really suck:thumbdown: Good Luck, keep us posted:cool:

The actual lap band surgery IS covered but the extra services which they call "bariatric resources" is not covered. I asked the UHC rep if this really mattered and she said probably all the things I would need could be done through the surgeon, as Jodi stated above. All the bariatric resource people do is find you a surgeon and cover other stuff with you, so it's no big deal that my husbands employer doesn't carry this extra service. I'm not sure if the extra service helps or hinders your approval, but I'm just glad to know that the procedure is covered and I had 2 different UHC reps plus the bariatric resource nurse that I talked to confirm that the lap band was covered under procedure code 43770 (in case anyone wants to know the code:cool2:) through my insurance. Now I guess I need to take the next step, I do have a BMI of 35.1 and I am diabetic, I have PCOS and I have knee and back pain so hopefully that will be enough to get it approved. *keeping my fingers crossed* I'll keep you all updated as to how it goes

I called my insurance today (United Healthcare) and Lap Band is covered at 90% which is awesome but then I was told I have no Bariatric Resource coverage, which I guess is just a service some employers pay extra for, it covers having a team find you a doctor and I guess they work with you and help you understand the procedure, aftercare, etc. I'm guessing this is no big deal because I have already found a surgeon close to me (1 1/2 hrs drive away) and I'm sure he will give me the info on the surgery, etc right? And this surgeon is in my network so there shouldn't be any problems. The question I do have is; when I asked what the guidelines were for the lap band all the lady could give me was the "generic" version off something she was reading, she stated you must be obese and have health problems relating to the obesity, she did not give me any BMI numbers or anything???? When I visit my PCP and he sends me to the surgeon will they be able to get all the guidelines? I really wanted something in writing to take to my Dr. so he could see the guidelines. Well I guess I'll just go and if I get denied I'll appeal it.:laugh:

I was so happy to find this thread. I also have UHC choice plus and I was a little concerned about whether or not I would be approved. My BMI is 35.1 and I have PCOS, I had gestational diabetes with both my pregnancy's and my paternal grandmother and father both had diabetes. (both died in their early 60's) I also have documentation for the past 6 years for weight loss consults through my PCP's office (he has had me on every prescription drug out there and none of them worked) but I dont think my BMI was over 35 everytime I went. My sugar level is very close right now to putting me in the diabetic catagory and I'm really hoping that I can get my insurance to approve the lap band. Dose anyone know if I have enough "stuff" to get this approved?

Thank you Mely, it makes me feel much better knowing someone close to my size was aproved. I have UHC and I'm hoping they wont give me a hard time....lol

I think only you can answer which way you want to go with this, but if it was me I would go with the band. If something happens later in life the band can be removed, if your not losing weight in can be replaced with a smaller band. I just think the lap band is a much safer route to go, just my 2 cents :thumbdown: I have a friend that had the bypass done and she was one of the unlucky one's that had a horrifying experience, I'm sure you've heard a few of them, but anyways she is fine now and the only thing she has to on a regular basis is get b12 shots monthly. Good luck to you I'm sure you will make the decision that is right for you:wink:

Welcome, I'm new on here also. I have not had the lap band yet but am hopefull that I will be able to in the near future. Best of luck to you :thumbdown:

Welcome, I am also new to this site. I wish you all the best :thumbdown:

Yes thats what I am afraid of...Denial..... but I do have documentation for the last 6 years from my Dr. for visits all relating to weight management, he has put me on every known prescription weight loss drug out there and none of them worked very long. Do you think that would help with my insurance?

Hello my name is Maggie and I am addicted to food....:thumbdown: I am new on this site and have not yet made the "appointment" to see my physician. I am 5'7" and weigh 224#, my BMI is over 35 and I have PCOD which makes me a high risk for diabetes (which also runs in my family) I guess I am just afraid that my Dr. or insurance company will deny me so I'm fearfull of going. (Stupid right?) I should just woman up and go.