I am miserable because i am fat. I am way over weight and the insurance dont think my problems, not to mention my weight, isnt enough for surgery. i am about 5'4 and 300lbs with a bmi of about 50, i have hip problems, knee problems, swollen ankle problems, back problems, and due to those problems i can not exercise, right on the line of having diabetes, i have had one child 4 years ago gained 100lbs during my pregnancy, also saw a nutritionist during my pregnancy. Yet all these medical problems are not enough to approve my consultation to see a surgeon. They said my bmi must be over 60 or have 6 months of professional weight management. 6 months?!?!?! who has 6 MORE months to wait around and not do anything about their weight!!!!! not me... im so discouraged right now. i waited like a month to get denied and now im having to wait another month to hear back from my appeal... and then for them to tell me that i will need to go another 6 months to even see a surgeon and then finish all the rest of the tests and stuff they have you do! ughhhhhhhhhhhhhhhhh... i just wish things were more black and white then this.

Check list:

over weight at least 100lbs CHECK

health issues due to weight CHECK

bmi 40-60 CHECK

APPROVED! simple right?

why do they need to make it so dang hard for over weight ppl to get healthier! thats all they rant and rave about on the news and online every where you turn its about over weight ppl and better your health right?? so why does it seem impossible to get this surgery?!

i was super excited to know that my insurance would pay for lapband and now to find out quote unquote "because to the budget cuts they are very strict on who can get the lapband" so ill rephrase what that means, we dont want to pay for it if we dont absolutely life or death which means you are on your death bed have to.

i guess i can quite ranting and raving myself. just needed to let out a little steam

do you have to have a referal from your dr? I just went to an informational seminar one day, they gave me paperwork, I filled it out, sent it in, two weeks later my insurance approved me, and i was off and running. Did not need my primary dr. to refer me.

You are definately a candidate for surgery. Find another route, they are yanking you around!

well when i called the insurance to find out if they paid for lapband they said they did if my primary dr agreed it was needed. so thats exactly what i did i talked to my dr and she agreed and sent ina referal

When I started my journey, I told my Primary he said fine ( I did not referral to Bariatric Dr.) I found one that was in network with my insurance, went to his informational seminar, made an appointment with him, his office found out what I needed to do to get the surgery. My BMI was 51. I did have to see the Bariatric Dr. for 6 months for documentation needed by my insurance company. I did my 6 months, took all of my tests the Dr's office sent in all my paperwork to the insurance company and I was approved in 24 hours. I had my surgery 2 months later. So it took 8 months. Sometimes we have to wait for things to happen. Now 7 months later and 72 lbs lighter I am happy it happened. Good luck to you and you should just go through the process. The wait will all be worth it.

I'm sorry, I misread your post. I thought your primary wouldn't refer you. Well, you seem to have enough stuff going on to warrant surgery. Keep pushing, many have pushed and won. But, 6 months isn't so bad. It seems like forever but your alternative is to put more weight on to hit their recommended 60 BMI, which certainly would not be the answer.

Seems kind of rediculous (the insurance companines requirements) I wish you luck.

thanks. im just kind of on a timed schedule im getting married next spring and i wanted to fit into a decent size wedding dress by spring of 2012 but with all this extra going to ruin that

I'm sorry, I misread your post. I thought your primary wouldn't refer you. Well, you seem to have enough stuff going on to warrant surgery. Keep pushing, many have pushed and won. But, 6 months isn't so bad. It seems like forever but your alternative is to put more weight on to hit their recommended 60 BMI, which certainly would not be the answer.

Seems kind of rediculous (the insurance companines requirements) I wish you luck.

that was my fault the ones who denied it was the insurance doctors?? i guess all my stuff goes through another doctor that i dont see and goes off what my primary dr says and determines if its needed or not

I'm sorry you're having to jump through all these hoops. I had to do the 6 month supervised weight loss program too. And it had to be documented by my primary care physician.

So make an appointment with your doc asap. Tell him/her you started weight watchers or whatever (see if they need paperwork or proof of some kind). Get this process started YESTERDAY. The clock is ticking. You want to get that 6 months started right away.

Because here's the thing: six months are going to pass anyway. You can be doing what you need to do to get this surgery. Or six months from now you can still be frustrated. Take care of it. The time will go by and you will get your surgery.

The determination, guts and persistence you need to get it done will serve you well once you have your band.

Good luck to you!

If you went to a seminar they would have told you that you have to have 6 months of supervised nutritionist, 6 months of seeing your general physcian then your physician has to submit a letter of necessity for the surgery. Most insurance companies are going to deny you if you have not done all the steps necessary its their way of discouraging you. So with that being said you need to start first with the seminar of a bariatric surgeon and start seeing your doctor monthly for six months and no loss of time in between.

thanks. im just kind of on a timed schedule im getting married next spring and i wanted to fit into a decent size wedding dress by spring of 2012 but with all this extra going to ruin that

Fall Weddings are beautiful!!!

Well, it's expensive! They don't want to shell out 10k for surgery if people can't stick to the diet. Not to mention the success rate of the band is fairly low.. so the risk for them is really big. I had an insurance that was doing that a few years ago, and they actually denied me. (I had already lost weight on my own, and I had no co-morbidies). Besides they pretty much only wanted to do bypass, because that is more of a sure bet for them.

If you can't stick to a diet for 6 months.. you won't succeed with the band. The band is essentially a diet for the rest of your life!! It just helps control your hunger. Knowing what I know now, I think the 6 month diet would be a good process to have. I still struggle with food everyday, and making good choices. Besides, what's wrong with losing weight before you get the band? Wouldn't it feel good to lose 30lbs then be rewarded with surgery to help with the rest?

I had to do my 6 mos twice due to a gap in the middle...........My fault

Start it ASAP

The time will fly by

My year did

Honestly, this is one of ,my favorite topics to rant about.....I can think of no other surgery that requires a six-month wait, a psych eval, nutritional counseling and various other tests just to get the treatment for a documented medical condition. It is called morbid obesity for a reason. And the lap-band is a well-documented successful treatment or the FDA and your insurance company would never approve it!

That said, I had to jump through the hoops and I did get my surgery. It took me 9 months, but at least it happened.

All of this is just another way that the insurance companies keep making huge profits. Our society deems it acceptable to pick on fat people and we let them get away with it. Can you imagine if insurance companies started requiring psych evals to see if you were emotionally prepared for your knee replacement or your cancer surgery? The requirements for this surgery have less to do with our health and more to do with the bottom line for the insurance company.

My recommendation for you is to jump through the hoops like a trained seal. Fighting it won't get you there faster. Don't think you need to be successful on the 6 month diet, either. I actually lost 30 lbs and gained 35 back before surgery. No one cared about it. They said it was documentation that I needed surgery.

Congratulations on your Spring wedding. You will be beautiful no matter what size you are.

Cindy

Honestly, this is one of ,my favorite topics to rant about.....I can think of no other surgery that requires a six-month wait, a psych eval, nutritional counseling and various other tests just to get the treatment for a documented medical condition. It is called morbid obesity for a reason. And the lap-band is a well-documented successful treatment or the FDA and your insurance company would never approve it!

That said, I had to jump through the hoops and I did get my surgery. It took me 9 months, but at least it happened.

All of this is just another way that the insurance companies keep making huge profits. Our society deems it acceptable to pick on fat people and we let them get away with it. Can you imagine if insurance companies started requiring psych evals to see if you were emotionally prepared for your knee replacement or your cancer surgery? The requirements for this surgery have less to do with our health and more to do with the bottom line for the insurance company.

My recommendation for you is to jump through the hoops like a trained seal. Fighting it won't get you there faster. Don't think you need to be successful on the 6 month diet, either. I actually lost 30 lbs and gained 35 back before surgery. No one cared about it. They said it was documentation that I needed surgery.

Congratulations on your Spring wedding. You will be beautiful no matter what size you are.

Cindy

thank you. i totally agree you always here about the over weight ppl needing to do this or that to help with their health but when it comes down to it, its not about us its about the money. we shouldnt need a pschy eval to get a tool to help us loose weight and have a better life and if a 6 month professional diet would have helped i would have lost weight when i did it 4 years ago when i went to a nutr for my pregnancy!! but that didnt do one little thing to help me.

Really, yes it is only about the insurance company trying to save money...they dont give a rats ass about your health or well being! Mine sucks so bad I had a choice to gain 25 pounds or self pay and I chose the latter...glad I did! Anyway this is not about fitting into your wedding dress...its about not being fat and miserable because of it...suffer the six month diet but be careful not to lose too much or too little weight...read a blog by band_groupie from the beginning and you can laugh with her thru the stupid insco bull and the six month diet...good luck sweetie....don't let those devils make you quit! I wish I had done this long a go!!!

We are all here to cheer and nag you on and even give a bitch slap when needed,,,you CAN do this!!!

thank you. i totally agree you always here about the over weight ppl needing to do this or that to help with their health but when it comes down to it, its not about us its about the money. we shouldnt need a pschy eval to get a tool to help us loose weight and have a better life and if a 6 month professional diet would have helped i would have lost weight when i did it 4 years ago when i went to a nutr for my pregnancy!! but that didnt do one little thing to help me.