Opening this up for discussion, not judgement or criticism.

One of the things I've witnessed here that has always made me raise my eyebrow a bit is people's questions about -- and others' willingness to help -- "beat the system", so to speak. I haven't seen the topic come up in a while, but when I first joined it was fairly common for someone to want advice on how to qualify for the lap-band, even though they don't qualify. And there was a lot of advice given about putting sand in clothes, weights in shoes, forcing down a gallon of Water before being weighed, etc.

Opening this up for discussion - in general - is it ok to "nudge" the system this way? Is there anything wrong with doing it? What's the line between what's "ok" to nudge, and what isn't?

wantlapband; in many cases things like this are taken into considertion and you don't have to re-qualify for surgery as if your first surgery had never happened.

Good question though! I know I certainly would not want to gain all that weight back just to qualify, but then, it would be really hard at that point just to maintain!

The reason I asked was because I am 205, BMI 35.3 and I have some co-morbities and I really would like to have lap band surgery. I've researched it for a long time. My weight just keeps going up. 205 might not sound alot to some people, but to me, its a burden on my life. I am not as healthy as I once was. I miss being at 115-120 lbs. I think I deserve to have a chance at having lap band surgery done. I am still obese. If you put me next to a someone who weighs 300 I might look skinny to them, but i'm not. I'm just saying I guess lightweights as myself with health issues should get a chance. If I don't have surgery I know I will get depressed, I already am due to my weight, but I will def. get worse.

I am not one of those women who just want it to and expect everything to be okay. I know it will be alot of work and a lifestyle change. I am prepared for that. My husband is prepared for that. It would actually be the best thing for this family as everyone will be eating smarter.

I go on thursday to see the surgeon. I'm scared he will say no. I see my cardiologist today, I will talk to him more about it, he is 100% for it and suggested I see only this one surgeon for it.

I have BCBS of MA. All my records state how I have tried to lose weight, so that is good. I am on xenical now (the insurance company approved it) but I have not lost any weight. Per the insurance company I am suppose to lose 12 lbs in 3 months. Well its almost 3 months and I have lost nothing, actually gained a lb. I have cried to my PCP and therapist many times about my weight. They know my struggles. I know I gained a bunch of weight after my mom passed away suddenly 3 years ago of a heart attach, she was 59.

Wish me luck!

I thought about going on an eating binge for a few months until I reached that magic number...but instead I just did self-pay and got it done.

I agree it is wrong to defraud the insurance company...but at the same time, a man who has been 100 pounds overweight for years and years should still qualify even though the bmi is lower than what the insurance companies set.

You nailed it. I am 85 lbs over weight and have been for years. My BMI is lower but still 35, I should still qualify. Its not fair.

wantlapband;

I do agree that it isn't fair that the insurance companies have just 'decided' what is or isn't allowed as far as approval.

If you are denied by your insurance, do you have any method for Self pay? There are some surgeons in the US that will band people under a BMI of 35, and surgeons in Mexico and other countries will do it as well. If I'd been given a chance at the band at 85 lbs overweight (or even 50 lbs overweight if someone had told me what my future would be like) I'd be all over it!

I don't have any money for self pay or any money to even get to mexico...

Way to go Kathy - you are right on the money! I'll say "AMEN" to all of that!

I think that it sad that people feel like that they have to do that.. But I also think that it is sad that some insurances say that you have to be 100lbs over weight before they will give you surgery. So I am not sure what I would do.. If I only needed to gain 10-20 more lbs I might cheat I know people who have put on alot of weight to get it.. I think if that is truly the only thing holding you back maybe? but the people who go and get it with only 40 lbs or less to loose so that they look like a model in a swimsuit I think that is selfish and sad. I do not think that this surgery is for someone who does not need it. Someone who needs to loose weight or has health issues then yes but for vanity no!

Kathy,

I totally agree with you!!!!!!!!!!!!!!!:clap2: :clap2: :clap2: I am an RN and I am looking for a surgeon to do the lap-band surgery myself. I to have eaten myself to obesity and was not forced by anyone to do so. I to ate fast food to the point of almost killing myself, but I was not forced by any resturant to do this to myself. I am addicted to food just like most of the people on this website are. This surgery is not performed on people who have medical issues that caused their obesity. Our medical system does have some problems, but so do other countries who have totally government controlled medicine, such as Canada and the UK. If I need my gallbladder removed, I don't have to be on a waiting list to have it done unless it's an emergency. If I have a blocked coronary artery, I don't have to wait a year to have a stent placed or bypass surgery because it can only by done in certain facilities in the country. I can also go to my local hospital or outpatient facility to get an MRI instead of having to drive for hours because only certain hospitals are allowed to have the machine. Even though so many Americans complain about our healthcare system, I'm not so sure they would want it changed to what other countries have now. I have worked with numerous Canadian nurses who were working in the USA because their government had closed so many healthcare facilities there and they were unable to find a job after they graduated from nursing school. Do we really want that in our country? Hum..........Yes, our insurance companies do not pay for many things our physicians deem as medically necessary, such as WLS, but things could be much worse. I believe many insurance companies refuse to pay for WLS because there was such a high mortality rate in the recent past. I have personally known 3 people who died having WLS done, so I can see the reasoning of insurance companies in the past. I think this will eventually change as the surgeries become less dangerous for the patient. The Lap-Band has already done wonders in this area. However, I don't believe 2 wrongs make a right either. I believe the insurance companies should but out and let physicians treat their patients the way they feel necessary again instead of having to rush patients out of the hospital because the insurance industry has set limits on how long a patient should be hospitalized for a particular procedure. Not all patients fit the textbook patient the insurance companies set their standards by. So, I can see this delimma from both sides. The doctors should be making these decisions, not the insurance companies. But, would the docs try to cheat the system even more than they do now?????????????? Just some food for thought!

Well, how about this?

My insurance doesn't pay for ANY weight loss surgery. So this is not an issue. How simple it makes life!

I think more insurance companies are going to follow suit, especially if they feel they are being defrauded.

All of this is irrelevant, because anyone who wants the band regardless of their weight or BMI can have it done in MX or any other foreign country for alot less then one would have to pay here.

I finally got the surgery. My BMI was 39.3, I was denied right before my surgery. I got the letter, called my doctors office they got on the phone with BC/BS Anthem of NH, and they approved it..within 2 hours, so I was able to get the surgery done.

It is the best thing I have done. Yes it was hard for the 1st few weeks, but I stick to the diet plan, and have lost 22 lbs since September 20th!

I wish everyone luck! Hang in there

Well La madam,

There are more people in America who can't afford to have surgery done in Mexico or any other country as far as that goes. I am one of those! I am disabled due to a very serious lung infection I caught from a patient while I was a RN caring for critically ill ICU patients! Did I get any workman's comp because I caught this at work? NO I DIDN'T!!!!!!!!!! I lost my job because of the family leave act and lost everything I owned, including my house! I, like so many others on here, don't have the extra money to go to another country to have WLS of any kind. Am I depending on Medicare to pay for my surgery? Yes I am! I worked from the time I was 17 years old until I got sick at work about 4 years ago. I am not just a lazy person trying to beat the system here. I went without 1 thin dime coming in for well over a year and had to fight "the system" to get my disability. So, not everyone thinks this is IRREVELANT! I have paid a large portion of my income all of my life for taxes and Medicare, so I do believe I am deserving now. I do meet the criteria for the surgery, so I'm not concerned about that part of it. I'm concerned about the other people who have spent their entire lives working and paying insurance premiums to insurance companies who refuse to pay. I, for one have never worked for a company who would cover any kind of WLS. All of them had riders stating they would not pay for it, but does that mean people shouldn't have the surgery paid for by their ins company? I personally don't believe it does! Most people pay a huge portion of their income for insurance coverage for them and their families every pay check. There are also millions of working American's who can't afford to pay for insurance coverage. So, yes our country has many problems with needed medical care for low income families and others who live from pay check to pay check. Plus I have to add, I am very fortunate to receive the amount of disability I do get because I was a nurse and made good money for the last 15 years I was able to work. Having this surgery will very likely save the government a lot of money in the long run because of the co/morbities I have and the possibility I may become able to return to nusing in some capacity.

As for the discussion about there being payoffs people get for their weight. I am very much a Dr. Phil fan and do agree with him on many sides of this issue. I do think we sometimes subconciously get something we either need or want to receive from our weight. I don't want to offend those who have gained their weight due to taking steroids or other medications at all because much of my weight has come from the same things. But, there are many things that have happened in my life to make me want to remain fat because of the pay off I get from it. Those are very personal issues I will not discuss, but they do exist and I am finally very aware of them. I believe one has to do a great deal of soul searching and "getting real" with themselves to discover these pay offs, but if most people really dig deep into their lives up to this point, they would probably be able to discover their subconcious issues. Plus, I am a food addict! The combination of the two has almost killed me and I am ready to make changes in my life to lose the weight. I have cardiovascular disease, probably diabetes, etc and am willing to do what it takes to become thin again.

So, I believe parts of what everyone who has posted on this thread is correct in some manner. It's all a matter of each individuals life experiences and their perspective on the issues being discussed here.

Hello everyone. I was a lower BMI patient. I paid myself, and my insurance does not cover it anyway. I was "only" 70 lbs overweight, but it was getting higher and higher every year. I exercise regularly and have tried multiple times to lose weight and keep it off. Should I wait another 10 years til I gained enough weight from all my failed attempts? Should I have wasted what was left of my youth until I had diabetes? Oh, and my weight is a job requirement and goes on every performance evaluation. Should I have waited til I was heavy enough to lose my job? Even if it wasn't an overt job requirement, how many people don't get that job or promotion because of someone's bias against heavy people? I think it should be up to the doctor and patient. If insurance does not cover it, that is their choice and they should not be lied to. I would have borrowed from whomever necessary to get this done, and I am thankful everyday I did.

Good luck to all struggling. Hopefully things will work out one way or another to get healthy.

Hello everyone. I was a lower BMI patient. I paid myself, and my insurance does not cover it anyway. I was "only" 70 lbs overweight, but it was getting higher and higher every year...

OMG, exactly!

Sometimes it happens without notice.

Those few extra pounds turns to 40# overweight, then the 40# over turns quickly to that "only 70#" like you faced, and one day that is now 90# or 100# overweight. Next thing you know, it's morbid obesity and that's not far from super-morbidly obese.

Every single bariatric surgeon I know (and I know quite a few, LOL) says that early intervention is key for higher patient success, and lower surgical risk. Ask any bariatric surgeon if they'd rather see a patient 70# overweight or 170# on the Operating Room table.

But yet here we are: WLS patients judging those desperate enough for extreme measures (and yes, flying to a foreign country for surgery is an extreme measure to me, because many would prefer not to go that far. )

Remember flying abroad due to cost is no less extreme than gaining weight to qualify to have it here. Either way, it's unfortunatel :phanvan

Yes, I say unfortunate. And no matter what - almost ALL self-pays I know would have had it here in this country if the price had been more affordable for them. There are always exceptions who could afford to go anywhere, and they proudly let us know they chose XXX country due to their exceptional surgical reputation. Hey, that's fine, but they are still the minority among self-pays. Most have to choose by price.

And I hate that we have to put price-tags when it comes to our health. I just hate it.

Oh, and my weight is a job requirement and goes on every performance evaluation. Should I have waited til I was heavy enough to lose my job?

Now this is very, very intriguing.

What do you do for a living, if I may ask, that weight is a job requirement? Are you a flight attendant (nope that federal lawsuit ended the weight requirement for U.S. airlines)? A Ballet Dancer? A Fashion Model? C'mon. You gotta tell us!

Even if it wasn't an overt job requirement, how many people don't get that job or promotion because of someone's bias against heavy people?

So true.

I absolutely don't do any of the above professions, yet I make more money in the hated hell of Corporate America when I weigh less. I can make a clear chart that shows my weight and corresponds with my income. It ain't pretty - the heavier I am, the less people want to pay me to do the same job. And that's if they overcome their prejudice to GIVE me the job in the first place (which sometimes doesn't happen).

Face it, the more you earn in this country, the less people expect you to be overweight.

And if you're rich? Forget it.

(Ask Oprah, ask Star Jones, ask Wynonna Judd, ask Roseanne Barr ... we take special pot shots at someone here who dares to be rich and fat. :faint: )

If I dare go back to the hell of Corporate Job-Hunting... we'll see if it's different now that I'm back to a normal-ish weight. I don't think I'll like the answer, frankly.

Sorry, I didn't mean to be cryptic. I am in the Army, one of the few institutions allowed to legally discriminate based on physical limitations. I understand why, though. It was definitely alot harder to lug all my crap around (30 pounds was the vest and armor alone) in Iraq being overweight. They believe it is all a matter of will power though, so no helping with weight issues. I am also concerned they could use this (the lap band) as a reason to kick me out, but thankfully they are so short of people right now, that if I don't tell them and make a big issue of it, they probably won't either. But I get weighed in every 6 months, no matter what. As for leaving the U.S., I would have paid more to do it here in the US, but the surgeon in my area would not even return my emails because my BMI was not high enough. Funny, he will now do my fills and see me, but would not have done the surgery. Oh well. My doctor did have more experience than the doctor here though, so it wasn't really a difficult decision. An with my BMI at 34, I don't feel it was vanity. And why should this surgery not be allowed by certain weight people? (Warning: tangent!) Cosmetic surgery is often for vanity, and carries many of the same risks as lap band, with the general anesthesia and infection, etc. No one tells them they are not ugly enough! Or that their boobs are already big enough! If you want it, and can pay for it, there are no "standards" saying you are too ugly, too pretty, too busty, etc. I mean some men get calf implants! Anyway, sorry for the tangent. I just think it is a decision the person and their qualified medical professional should make, not some arbitrary number.