PacifiCare Came Through---YAY!!

L8BloomR · February 10, 2008

To anyone who has had Pacificare HMO cover their LapBand surgery would you mind sharing what your starting weight was and if you had major medical problems? I am just starting the process to get Pacificare to cover surgery. My Dr. is sending me to a dietitian for 6 months and a physical therapist. I am only 252lbs but I have tried everything including working out with a trainer for 1 hour a day, 3 days a week for 6 months while doing Jenny Craig and did not lose a pound. I do not have any medical problems but I am not getting any younger and every year my weight keeps creeping up. I know it is just a matter of time before problems start to show up. Any advice you can share will be appreciated.

I don't think it is a question of how much you weigh, it is probably more a question of how overweight you are. I was almost 100 pounds overweight and was approved for the band (and for gastric bypass, as well.) I was told that to get banded you must be at least 75 pounds overweight, or have major health issues. I started this thread when I was told I had to do a 6-months online diet program even though I have battled weight for many years and it was documented by my doctor. Then suddenly Pacificare HMO approved the surgery one month into the program! I think it is a great idea to start this process now before you get heavier or have more health problems. I have found Pacificare to be very good at covering the needed tests, surgery and post-surgical care. They covered my fills for 1 year, but now I need to get authorization before I get additional ones.

Good luck with your band journey! I hope you have as good an experience with Pacificare as I did. Keep us posted!

rottimom · February 10, 2008

Thank you so much for responding. You give me hope. I just hate to wait 6 months only to have them deny me. I have a BMI of 40 so I just make the cut off but I have no medical problems. I am 5'6'' so I could lose 100 lbs. But I have been trying for over 20 years to lose this weight and my family finally said they would support me having the surgery which I am going to need for after surgery care. So I am ready to pay for the surgery if I have to. But if insurance would cover it then I could save my money for the cosmetic surgery that I am going to need after I lose the weight to get rid of the extra skin.