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Will Bcbs Approve My Lap Band, If My Pcp Is Against It.



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Im new to this site, I just started my testing process on June 13,2012 and so far I have completed the UPPER GI, Psych Eval, sleep Study ( got the results today and Yes I have Sleep Apnea). I have 2 Dietary consults left. My question is I have the Diagnosis of Hypertension, Sleep Apnea, knee pain, early signs of insulin resistance and a BMI of 42. Can my PCP slow down the process,shes somewhat against the surgery , but keeps stating that I need to lose weight and that my symptoms would decrease.

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That all depends on your surgeon and insurance. For instance my surgeon requires a letter of clearance from your pcp stating that you are healthy enough & cleared for surgery. My insurance doesn't care what my pcp says but some insurances require a referral or for your pcp to be on board.

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My insurance didn't require any information from my PCP and my surgeon handles his own pre-operative clearance (after getting cardiac, pulmonology and psych clearance). So hopefully that won't hold you up!! If I may ask, why is your PCP against you having this surgery?

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Im new to this site' date=' I just started my testing process on June 13,2012 and so far I have completed the UPPER GI, Psych Eval, sleep Study ( got the results today and Yes I have sleep Apnea). I have 2 Dietary consults left. My question is I have the Diagnosis of Hypertension, Sleep Apnea, knee pain, early signs of insulin resistance and a BMI of 42. Can my PCP slow down the process,shes somewhat against the surgery , but keeps stating that I need to lose weight and that my symptoms would decrease.[/quote']

My OBGYN doctor wrote my letter. Did not have to do sleep study, EDG and only dietary class. My pcp does not even know I am having surgery. So it depends on your surgeon. My employer also made a deal with the insurance company to cover 75 percent. I work at a hospital do it it all part a wellness incentive package for employees who want to have it done.

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Thanks everyone for the feedback, My surgeon gave me a letter of recommendation to give to my PCP to complete,so I have an appointment this month with her. To JessiG1983, My PcP states that she has not heard a lot of success about the Lapband and I would probably loose only 5 pounds a month. She doesnt understand because she maybe weighs 120 pounds. I have been struggling with this weight for about 8 years and she knows that Its really affecting my health in negative ways. So I will see what she says, I will keep you guys posted. Thanks again everyone, wish me luck.

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I have BCBS and a letter from PCP was required. Maybe you surgeons letter will help.

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If you have a *** it's more managed. Do you need to get your complete summary of benefits and read the bariatrics portion or obesity portion or call you insurance and ask hours that department and they can tell you.

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    • LeighaTR

      I am new here today... and only two weeks out from my sleeve surgery on the 23rd. I am amazed I have kept my calories down to 467 today so far... that leaves me almost 750 left for dinner and maybe a snack. This is going to be tough for two weeks... but I have to believe I can do it!
      · 0 replies
      1. This update has no replies.
    • Doughgurl

      Hey everyone. I'm new here so I thought I should introduce myself. I am 53y/o and am scheduled for Gastric Bypass on June 25th, 2025. I'm located in San Antonio, Texas. I will be having my surgery in Tiajuana Mexico. I've wanted this for years, but I always had insurance where bariatric procedures were excluded. Finally I am able to afford to pay out of pocket.  I can't wait to get started, and I hope I'm prepared for the initial period of "hell". I know what I have signed up for, but I'm sure the good to come will out way the temporary period of discomfort and feelings of regret. I'd love to find people to talk to who have been through the same procedure or experience before. So I look forward to meeting you all. Hope you have a great week!
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    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. LeighaTR

        I hope your surgery on Wednesday goes well. You will be able to do all sorts of new things as you find your new normal after surgery. I don't know this from experience yet, but I am seeing a lot of positive things from people who have had it done. Best of luck!

    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

    • CaseyP1011

      Officially here for a long time, not just a good time💪
      · 0 replies
      1. This update has no replies.
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