seriously considering getting the lapband

[babyk 1]

i am 20 years old. female

5'5 235 pounds

i have been heavy my entire life but have gained over 70 pounds in the last year alone. my father passed way and i quit smoking. i am so miserable being overweight. i have tried every thing known to man kind to lose weight and nothing works permanently. i have lost weight several times and have ended up gaining back everything i lost plus so much more.

i am really considering getting the LAP-BAND® and have a few questions.

would i be a candidate? (my bmi is a 39.1)

has any gotten the LAP-BAND® in los Angeles? i live here and have ppo insurance.

were you able to get financed?

how should i bring this up to my family!?

any help would be greatly appreciated. thanks :]

[Becca29 0]

Congrats on your decision! I just told my family after I started the process and theyve all been pretty much supportive. I know it can be hard for some but we are very close so it wasnt an issue. LapBands done in the United States have certain requirements on BMI. I believe its as follows. 100 or more overweight. A BMI over 40 or a BMI of at least 35 with weight related health conditions (co-morbities) I have insurance and my BMI is a 36 and I qualify for the band. Good luck to you. This website is full of alot of great information.

[reverie 49]

We're kind of around the same stats so good luck if you do decide to go with Lapband!

For one, most insurance companies require a BMI of 40 or a BMI of 35 with two comorbidies. Since you're so close to 40, maybe it'd be beneficial to gain a pound? That sounds silly but unless you have comorbidies, you may have problems.

You may want to look in the California state forum to find people who have been banded in LA. :thumbup:

[babyk 1]

wow thanks for the advice :]

@ becca29: how did you bring it up to your family? I am afraid since I am "young" that my family will be hesitant. I live on my own and work and go to school so they know I am responsible. i am just afraid that they may not agree with it. i wouldn't know what to do with out my family's support.

@reverie: i understand what you are saying about gaining a pound. i was thinking the same thing. thanks for the advice :] what was the process for you as far as getting approved by your insurance?

[Laura Lane 0]

hi, i got mine in mexicali with dr. aceves. i really recommend him. he's great and his staff is very professional and most of all reliable. on telling your family, well i would suggest for you to sit down and talk to them and tell them how you feel and that this is a very good option for you. you won't regret your decision. goodluck and please keep us posted.:thumbup:

[kcarny 0]

I wish I had this done when I was 20. Having the surgery now, while you're still young, can change your life before you hit the best part of it. I'm sure your family wants you to be happy and healthy. I'm sure they'll have questions. My mom went to the seminar and my first doctor's visit with me. After that, she was the biggest supporter of the surgery. You're already doing your research, go talk to your primary doctor, and the rest will start to fall into line. Good luck with everything :thumbup:

[babyk 1]

@ Laura Lane: I have been researching placers in Mexico as well. What can you tell me about the place that you went? Were the facilities nice? How much did you pay? (if you don't mind me asking) i will definitely keep you posted thanks for caring!

@kcarny: thanks! i've stuggled with my weight for my entire life, which i am sure most of us here have. i'm tired of being miserable. thanks for the advice. i am going to ask my grandma to go to an appointment with me. I am going to the seminar this weekend and my boyfriend is coming with me. he is very supportive. what is the next step? i do not have a primary doctor at this point.

[kcarny 0]

I needed a letter of support from my primary doctor to have my surgery approved. Maybe ask some people at the seminar if they can recommend theirs. A doctor who supports weight loss surgery is good to have. They'll go over so much information at the seminar and you can (and should) ask questions there. Once you find your hospital/surgeon, they'll lead you through everything.

[Amaris 0]

Every insurance company is different, and so is every doctor's clinic. I had to jump through all the hoops listed in my signature, plus watch an online video presentation (EMMI) about the surgery. I also had to have a letter of clearance from my primary care physician. Then a nurse had to sign off on my chart, whatever that mens, and they would submit to insurance. I'm going to call them today to see if they have yet submitted and if so, when.

NOTE: my journey is by no means typical, time wise. In the middle of it, my husband lost his job, and then my mother got sick and made her transition. WLS was the last thing on my mind during all of that!

Start by either getting a referral from your primary care doc, or doing some research and finding one yourself. Go to their free, informational, seminar. You may have to go to a couple to find the doctor you click with, but it's totally worth the time. Another place to start might be to call your insurance company (or use their online services, if they have them) to see if the lap-band is covered and what surgeons are in their network. Then pick from that list, and start going to seminars.

As far as telling -- I have only told a few people. Six, plus pertinent health care professionals. I just sat them down and told them I needed to talk to them about a decision I had made. I made it clear that I wasn't looking for permission or approval, but rather support, and I got it.

Because I've met my cap for out-of-pocket spending this year, I'm expecting there to be no cost to me, other than a $4,000 that is required by my doc's office, because they are out-of-network with my insurance. I don't have a real good handle on what that's for; I guess I'll ask them when I call later today. Anyway, I didn't need financing, so I can't help you there.

Good luck to you! I wish this had been an option for me when I was your age. YOU ROCK, no matter what decision you make! :thumbup: :thumbup:

[babyk 1]

@ amaris: wow thanks so much for all the info! I am trying to figure out whether i should go to an outside doctor that is affiliated with my insurance or go to a doctor that is "approved" by my insurance to get the referral letter. I am afraid that if i go to a doctor that is approved by my insurance and they deny me, that i will not be able to get the surgery. Any advice?

[Amaris 0]

@babyk, I didn't have any choices! There are no doctors in my insurance network within 250 miles, so I had to go with someone that just accepted my insurance. Given that, I just found a doc that I clicked with it. I really like my doc! He is out-of-network for my insurance, so I will have some out-of-pocket expenses.

Good luck, and ask more questions! Sorry I didn't have any better answers for you.

[babyk 1]

@ amaris: o no that's kind of a bummer! thanks for all of the advice. it is really nice to have some answers :thumbup: have you already gotten your band?

[Cocoabean 430]

I would call the insurance company and ask them if they cover it and what their requirements are. Also ask what your copays are for the procedure and office visits. You might even be able to read up on it online. My company's information is right there. Find out if with the PPO you need a PCP referral.

Find out what BMI they require and how long you have had to be there. If they require a BMI of 40 with no co-morbids but that you had to be 40 or over for 5 years, there is no point in purposely gaining to qualify. Find out what their co-morbidities are to see if you have any of them. Then with a BMI less than 40, you know you are OK.

Requirements are similar with insurance companies, but not always the same. Some have implemented a requirement of a certain BMI for 5 years, to disallow the purposeful gain of weight to quailify for surgery.

You can also ask for doctors and hospitals in the network.

Go to the seminar armed with this information.

If you are denied, your insurance company should have a grievance or appeal process. Cross that bridge if it happens.

[babyk 1]

o wow great info thanks! i am not sure that i have had a bmi of 40 or higher for 5 years. however, i have been "overweight" my entire life. i did have one year where i was probably considered "normal weight" but i was in the gym 4 hours a day and starving myself. (stupid, i know) i hope this all works out

[Cocoabean 430]

o wow great info thanks! i am not sure that i have had a bmi of 40 or higher for 5 years. however, i have been "overweight" my entire life. i did have one year where i was probably considered "normal weight" but i was in the gym 4 hours a day and starving myself. (stupid, i know) i hope this all works out

Babyk, being as you are so young, that 5 year requirement might not apply anyway. You would still have been growing up 5 years ago!

They might accept "overweight" or "obese" if you can show the history. Medical records will come in handy. Pictures, too, if you don't have medical records.

BUT, first step, before getting nervous about all that is to give them a call and find out. Asking the question will not cause any troubles with getting approval. It is what I did first.

When I first asked, bands weren't even covered. I was told that they would be covered the next year, so I waited a bit.