Hi Everyone,

I just wanted to share with you all that I've finally got a surgery date of July 24. After a year of waiting lists,testing and jumping through hoops, It's finally my turn. The only thing that makes me worry now is that my insurance company (BCBS of Ma) has new guidelines stating that if your BMI is under 40 with 2 co-morbid diseases, they do NOT have to cover you unless the diseases are to the very extreme, meaning you could die if you didn't lose weight right away. BUT my Dr. is pretty sure I'm okay. My BMI is 39.8 with 2 co-morbid diseases but, I do have many other medical issues that would benefit me if I lost weight, so the Dr. thinks this is what will get me through.

Now don't get me wrong.. I know that the insurance company doesn't have to cover anyone. I'm just stating that they've changed the severity of the co-morbid disease.

Anyway, wish me luck. I'm told that the ins. comp. will inform me either way. I'm not sure how long it will take, but i'll be waiting by the phone. How long did it take for any of you to hear from them?

Tell me how you got started. I don't think insurance will cover me. Although my bmi is high enough, I have no other major issues. We are planning to go to Mexico, but I don't even know where to begin.

Tell me how you got started. I don't think insurance will cover me. Although my bmi is high enough, I have no other major issues. We are planning to go to Mexico, but I don't even know where to begin.

For me, I just called my insurance company to see if they covered the surgery and if they did, what requirements did they have in order for me to qualify. Then I researched clinics in my area, picked one and got a date for a consult.

]

I also have BSBC MA, and I didn't know they had changed anything. I have my consult with the surgeon at Brigham and Womens on July 6th. My BMI is only 35, but I do have medical problems since gaining so much weight over the last 6 years. I gained over 70 lbs, and it keeps going up.

Wantlapband, I'd call the insurance company and ask all your questions. I went to Lahey Clinic in Burlington and my PA told me I was lucky because things have changed at BCBS of MA. My BMI is 39.8, I've had several back surgeries,HBP, joint problems in the knees and I have a intrathecal pump implanted. Anyway, I guess all the same rules apply, but the severity of the co-morbid dieseases have to be more severe, life threatening IF your BMI is under 40. Honestly, you have a lot going on.. but your BMI is at the cut off for coverage. I'm no Dr. nor am I an insurance rep. I'm just telling you what I have experienced. Doesn't mean that I am right and it doesn't mean my info. is any better than yours. I wish you the best of luck and please come back to let us know how it all works out. I think your good to go! I'll let you all know if and/or when I get approved. :eek:

I just got approved,( in a week's time)

Mr Dr sent in all the paperwork to the insurance (test results, why I need it, ect) on Friday the 16th. I called Friday the 23rd and they had approved the surgery. I know that the Dr put a "fake date" on the insurance forms. Meaning that he put 7-16 as the surgery date, but my actual date wont be till August, not sure which yet. So if Dr sent in all your stuff.. shouldnt take too long?

Hi,

BCBS New England (MA) said they will cover surgery if my BMI is 35 as long as I meet the requirements which I am sure I do. I have called and spoke to them regarding this a while ago, but its the doctors who have to submit all the paperwork to the insurance company to get approved. MY PCP is 100% for it for me, she knows I have struggled with my weight for about 7-8 years now. My cardiologist said it would actually be a good thing for me. I can't work out up to my capacity because of my chronic vensus insufficieny and irregular heart beats, I get all puffy, sore and my heartrate goes out and I start to get chest pains even being on my beta blocker. I use to be an avid gym goer and very thin (120) before all my health issues.

Anyways...the I'm sure my doctors will work around a way for me to get approved. It beats paying for all the other stuff my insurance has been paying for me. I'm pretty expensive to maintain :eek:... ($4,000 a month just for lovenox)..

Anyone have any input would be appreciated.

Thanks!

Debbie

Debbie, after reading your last post I can't see how the insurance won't cover you. I'm happy you have a Dr. backing you up, isn't it always nice to have someone on your side?:eek:

I wish you luck and hope you get a surgery date soon!!! Take Care

I just got approved,( in a week's time)

Mr Dr sent in all the paperwork to the insurance (test results, why I need it, ect) on Friday the 16th. I called Friday the 23rd and they had approved the surgery. I know that the Dr put a "fake date" on the insurance forms. Meaning that he put 7-16 as the surgery date, but my actual date wont be till August, not sure which yet. So if Dr sent in all your stuff.. shouldnt take too long?

YEAHHHHHHH!! Good for you. How awesome is that, in one weeks time. I think I'll call my insurance now.. Best of luck to you

I have been waiting for 3 weeks to get approval from my insurance company. Today I learned that my records were missing the 6 month dr. supervised diet. I have never used a dr. to supervise my diet , but have attended Weight Watchers and lost a few pounds and then gained them back. I was on more of a supervised diet when the dr. gave me phen pnen. I lost 60 pounds, almost at goal at that point 8 years ago. Then they took it off the market. I gained back that weight and 20 pounds more over the last 8 years. Four years ago as I was continuing to gain weight back they put me on phentermine and an antidepressent which I was told in combination might help me to loose, but it didn't do a thing.

Last January I tried Adkins for one month and lost 2 pounds and it was so restrictive I just gave it up as I wasn't really loosing at a regular rate. it took me all summer when I was on Weight Wathcers to loose 10 pounds, years ago. So...not only is loosing the weight difficult, but what weight I do loose comes back plus more.

So, I am not really interested in setting myself up for failure with a 6 month diet supervised by a dr.. I might loose a few pounds in 6 months, but, I have a histoy of gaining the weight back.

I may just have to do a self pay at $11,000, if they say I need to do the 6 month diet deal.

This is very frustrating at 230 pounds, as I am also trying to do something so that I don't follow the road my mother is on at 83 years of age overweight and is diabetic has had two knee replacements and two back surgeries.

I too have back issues with a bulging disk that I have received therapy for on two different occasions.

The dr.'s office is supposed to be talking with my insurance about the "missing" paper work, ie 6-month supervised diet. She will call me when she catches up with them as she left them a message today to see what all we were missing. I know this point will be their "out" from having to cover this surgery.

I think at that point self pay will be my only answer.

You can tell me to shut up if you wish and to mind my business, but I sense in you a feeling that the lap-band is going to make everything better without any work on your part. You seem to have given up. $11,000 is a lot of money.

Try the 6 month diet if that is required. Try Hoodia. Try Atkins again. If you think Atkins is restrictive, then the Lap-Band is going to be a failure. Atkins is a piece of cake as compared to the Lap-Band.

A Lap-Band is major surgery. People can die from major surgery. People have died from Bariactric surgeries, including Lap-Bands and complications from Lap-Bands. Neither Atkins, Hoodia or a 6 month supervised diet can kill you. People need to realize that this Lap-Band is not an easy way out.

If you think I am out of place, well I am sorry. But as a person who has had a Lap-Band for almost 4 years and is counted as a success, but still 60 pounds over-weight, I just want you to take full advantage of every option.

So, I am not really interested in setting myself up for failure with a 6 month diet supervised by a dr.. I might loose a few pounds in 6 months, but, I have a histoy of gaining the weight back.

I may just have to do a self pay at $11,000, if they say I need to do the 6 month diet deal. .

Yikes, 11 grand is a lot of money. 6 months really isn't that long to wait and in my opininon... if you failed losing weight, you pretty much show the insurance company that you can't stick to a diet. I'm not telling you to sabotage yourself, because I tried so hard to lose weight an I did lose a little. I think that the ins. comp. wants to see you make an honest effort, under a Dr.'s care, to try to lose weight at any rate, slow or fast and see how long you mantain it.. if at all. At the same point, I was not required to have a six month diet and I was quite surprised by this. BUT in my defense, I had documentation of medications and WW's, online programs and so on and I did submit it to the ins. comp.

If i'm getting this right.. you said that your paper work may have been missing. Is this the paper work you submitted? If so didn't you keep a copy? The Dr. usually never sends the orig. paper work to the insur. company.

Anyway.. Just like everyone else who is wanting or waiting for the band.. you wanted it done yesterday.. I understand completely. But take a step back and see what you can do before you just rush out and pay 11 grand. I'm not trying to be rude or mean. I'm just trying to be the devils advocate for a few minutes. I wish you all the luck in the world, please let us know how this all works out for you. I know your frustratations... If I get denied, I'll be right beside you. BUT i will not give up! I'll do what it takes to get this band because I want and need to be healthy.

DON'T GIVE UP... TRY,TRY AND TRY AGAIN! It might take you longer, but it may save you 11,000! Take care...

Also, I think Tired old man has made a few good points. Slow down a bit and see what happens. I've heard of some people waiting 2 months for approval. At least if your paperwork is found, the hard part is over with. You will get your answer pretty much right there. Once again, best of luck to you.

I had a great experience. I have UHC and I had surgery 5 weeks to the day I had my first consultation. That seems to be the exception rather than the rule based on comments about UHC in this and other threads. I previously had Aetna and it was a nightmare, I gave up on them quickly.

Dear Debbie

Call the 800 # on your BCBS card. Ask them to send you a copy of their medical policy on "Medical and Surgical Management of Obesity"

Its a few pages long - but the bottom line is:

"Patient Selection Criteria" states you must have a BMI over 40 OR that your BMI id 35 or higher AND you have one or more high risk co-morbid conditions which are

-sleep apnea

-Pickwickian syndrome (no clue what that is)

-Pseudotumor cerebri (?)

-obesity related cardiomyopathy

-Type II diabetes

-At least Stage 1 Hypertension based on JNC-VII (?)

-Coronary artery disease

-Obesity related pulmonary hypertension

hmmm-some things I never heard of!

Anyway-check it out-call them

And good luck! What hospital are you using?

Diva,

I am using Brigham and Womens Hospital since that is the hospital my cardiologist and other doctors I had for surgeries are at. Dr. Goldhaber (my doctor) only wants me to use Dr. Lautz.

I read all the terms on the BCBS website. I was approved for xenical but it is not working, been on it for more than 2 months, and like I said I can't take other meds due to my irregular heart beats and blood clots, they won't prescribe them to me, and plus I'm on blood thinners for the rest of my life.

I know doctors have a way to work around things so I'm hoping they will write up something for me to get approved. I think I should be approved. My mom died at 59 of a massive heart attack, heart disease runs in my family on the family side, no one has lived past 59.

Oh, I'm disabled because of my condition, have been for 4 years now.

I can't wait to see the doc next week

Oh another question for everyone.

After I meet with the surgeon will he set a surgery date if he feels I can have the procedure done, and then submits the paper work for approval. I know there are other appts you have to go to before surgery, I already have a psychiatrist that I see for meds so that will be easy, he will def. approve me to be fit for surgery, maybe I should make an appt to see him now? What do you think?

Thanks !