I've struggled all my life with being over weight and I'm at my wits end trying to lose weight and keep it off. So I want to look into getting the Lap-Band. I'm 5"9 and 225lbs. But I read on some sites thats not heavy enough. Can someone give me a little more insight on how they determine if you are a canidate.

Not here in the states, usually it's a 40 BMI or little less with co morbitities, illnesses, that qualify. I wasn't big enough either here so I went to Monterrey Mexico and had my done by the great Dr. Rodolfo Sanchez and it was only 8500.00 plus your flight.

The typical criteria for US surgeons is as follows:

• more than 100 lbs. over your ideal body weight, or
  
• have a Body Mass Index (BMI) of over 40, or
  
• have a BMI of over 35 and are experiencing severe negative health effects, such as high blood pressure or diabetes, related to being severely overweight

At 5'9" and 225 pounds, your BMI is 33.2.

Dr. Spiegel will do it if you are only 40 pounds overweight! I personally think that is insane, but I guess he doesn't.

I was a candidate for surgery, but my insurance wouldn't pay because I was under 40 BMI with only 1 co-morbity...I needed 2 for my insurance to consider paying. So, I private paid.

It's not a hard and fast rule with surgeons. TriciaK posted the generally accepted guidelines. I think those are followed pretty closely if insurance is going to pay for it. Since you are about 75 -80 lbs over ideal, insurance probably wouldn't pay. But possibly, a surgeon would do it if you were self pay. Wouldn't hurt to inquire.

I was 100 lbs over ideal weight, my BMI was around 37 and I have no comorbidities. However, since I was self pay, it was close enough.

I was 5'9 281 before my surgery. My BMI was 40%. Hope that helps.

Hi There,

I am also someone who has dealt with weight issues my entire life. I am at the top end of the age scale at 55 and the low end of the weight at 221 with a BMI of 35. I have Cigna Ins and I have a supportive GP, but it does seem ridiculous to have to go through the hoops that Cigna wants you to go through, 6 months of supervised medical discussions with your doctor etc., when there is a high likliehood that they will deny because I don't have heavy evidence of co-morbidity issues. My local hospital's case worker does not seem to be very hopeful of my being approved for insurance. This hospital has yet to be consider a Center for Excellence for bariatric surgery they think by early 2007.

I am waiting for my first visit with the surgeon and I have been reluctant to attempt to really lose weight until that meeting because I know he will want me to demonstrate that I can in fact stick to a regime. Although I am still exersizing regularly since May.

I would love to hear from others who are borderline, especially those who have managed to get approved.

My dilemma is whether to stick with this or try and work out the finances to self pay. I welcome any comments and suggestion.

Thanks

I know the feeling , I get frustrated cause I know this is the only way I can accomplish my goal. But they make it so difficult to get it done . I'm like 80lbs isn't heavy enough to get the surgery. Thats the weight of my 8 year old. A whole child!

Surgeons in my area advertise that they will band people 60 pounds and more over their ideal body weight. That would be self-pay, of course. No insurance company is going to foot the bill for Lap Band unless you have a higher BMI and/or co-morbidities.

Be sure you have access to local follow-up care. Many doctors will not do fills for patients banded in Mexico.

Good Luck!

I was banded last week, I am 5'4" and 203 preband. My BMI is 35 and I have highblood pressure and hx of diabetes in my family. My insurance is United and they approved in 2-3 weeks. Some physician's offices are very good in working with the insurance companies to get approval. So far it is worth the trouble of going through the process. What is a few months of headaches with the paperwork and recovery for a lifetime tool and better health?

You will probably have to self-pay if you do it in the States. I had a BMI of 37 and had several co-morbities but none severe enough to get my insurance to pay. I was sick of playing their game and jumping thru endless hoops so I went to Mexico with Dr.Ortiz ($8,500) and do not regret it one bit. Good luck to you!!

~Liz~

03/10/06

241/176/160

5'7''

Hi Liz,

Does Dr Ortiz do your fills too or did you find a doctors will to do that for you in the US?

What I am trying to determine before I spend $1000 for my first surgeon visit and psych tests is whether I should just direct all my energy and money towards doing this out of country as I am assuming the costs here would be a lot more.

I have a BMI of 39 and was approved in 3 weeks with my insurance company. I have asmtha ( which I had when I was thin) and Gerd which IS caused by my weight. Make sure you have all your medical records sent with your approval packet. I have had two stree fratures from my constant walking, (trying to lose weight) and that actually weighed in per getting approved! I have UHC.