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Will they let me get the lap band

hopetolose

By hopetolose, in LAP-BAND Surgery Forums

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hopetolose    192

hopetolose
Posted

I go for my doctor consult on the 23rd. I am 5'8" and 236 lbs, and have a bmi of 35.9. I am wondering if they are going to let me get the lap band. I am going thru self pay because I dont want to wait for insurance and they might not cover it anyway. The only things that I have wrong is back pain and bad pain in my joints in knees and ankles. I am wondering if I need to have some other medical problem if I am not over 40 bmi. ??

Has anyone else been kind of in my shoes as far as lower bmi and no co-morb stuff going on? :unsure:

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lv2h8me    2

lv2h8me
Posted

I'm 5'9 and 230, I am working on my approval thru insurance. I have diabetes, and GERD. With your achy joints I would think you could get it, since they have lowered the BMI to >30 in some cases. Good luck!

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hopetolose    192

hopetolose
Posted

I sure hope so! I am getting so excited to do it. It would be such a bummer if I couldn't. I really like this doctor from his seminar. They seem to have a very good post op support system in place. This seems to be very important listening to all the posts on the forums. It seems to be that when people dont have the post op support and correct fillings afterwards that they dont lose as much or not at all. Do you see that as well?

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hopetolose    192

hopetolose
Posted

I'm 5'9 and 230, I am working on my approval thru insurance. I have diabetes, and GERD. With your achy joints I would think you could get it, since they have lowered the BMI to >30 in some cases. Good luck!

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hopetolose    192

hopetolose
Posted

Hi Kimberly, when do you think your insurance is going to approve you? We seem to be about the same height and weight (given an inch and a few pounds). It looks like you have lost a little, what are you doing to lose right now? Good luck! :)

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Kalipso2    25

Kalipso2
Posted

i had a starting bmi of 36.6 and i was self pay. my surgeon never questioned my need for surgery because according to the bmi chart i WAS obese! being self pay helps a lot too... be prepared for things to move pretty fast once you decide for sure to have the surgery. i had my surgery within 5 weeks of my initial consultation since i was self pay.

having a lower bmi could mean a slower weight loss so be prepared for that.

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lv2h8me    2

lv2h8me
Posted

I'm hoping to get an approval in the next couple of weeks! I would like to get this done before I start my RN program in May.

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hopetolose    192

hopetolose
Posted

Oh That would be good. Well I hope that we both get our wish and have this done soon. I would love to keep in touch as we seem to be similar in size. GOOD LUCK!

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Portola Suzanne    3

Portola Suzanne
Posted

Oh That would be good. Well I hope that we both get our wish and have this done soon. I would love to keep in touch as we seem to be similar in size. GOOD LUCK!

I was a BMI of 36 and had the surgery, insurance I had even covered it at the time. My insurance has changed and they don't cover anything now so I pay for fills.

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chopperblue    1

chopperblue
Posted

I

I go for my doctor consult on the 23rd. I am 5'8" and 236 lbs, and have a bmi of 35.9. I am wondering if they are going to let me get the lap band. I am going thru self pay because I dont want to wait for insurance and they might not cover it anyway. The only things that I have wrong is back pain and bad pain in my joints in knees and ankles. I am wondering if I need to have some other medical problem if I am not over 40 bmi. ??

Has anyone else been kind of in my shoes as far as lower bmi and no co-morb stuff going on? :unsure:

If you are self pay you wont have any problems. Good luck!!! :)

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pennreporter    12

pennreporter
Posted

For cash, you won't have any problem...it's insurance companies that dictate the BMI. My daughter is 5-9 and weighed almost 300 lbs but had no comorbidities, so she had to selfpay. She did her homework on where she could get the best rate and the best surgeon for the rate. She lives in NYC. She went to Houston to Dr. Spivak (one of the top surgeons in the US, an incredible background) stayed with a friend of hers and the cost was 13,500. I think it's even cheaper now, whereas in NYC it was 25k plus. For cash, there were women in there at only about 50 lbs to lose. With insurance many of them require the whole six month program also. My daughter, it took her about two months, but mainly it was just getting time off from work. She never even met surgeon until the day before surgery. But he had such an impeccable background, she wasn't concerned.

So good luck.

Trisha

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pickles123    0

pickles123
Posted

There is a new ruling out there that lowers the BMI to qualify for lapband. The only reason I know is that my doctor was part of the process (study) and he e-mailed his patients about it.

Good luck!!! I don't think you will have a problem..

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pennreporter    12

pennreporter
Posted

it still is up to the insurance company. Mine still has a requirement of 40 unless you have multiple comorbidities. I skirted under the 40 because I had sleep apnea. Blood pressure, cholesterol, thyroid and arthritis didn't cut it. It was the sleep apnea that qualified me.

Good luck.

trisha

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