Hey Everyone!

I am new to this forum. I was planning on looking into LAP Banding, but after the weigh loss seminar I decided that the sleeve was the best option for me.

I just scheduled my physical exam, nutrition seminar and 1:1 meeting with the nutritionist. I still have yet to even tell my dr about my decision for the weight loss surgery as the last time I brought it up she pretty much told me that I dont need it and that I just need to diet and exercise. I have to schedule an appointment to see her and have the paperwork completed that is required by the surgon, but I did ask at the seminar if my doctor's approval was necessary. He stated that although he likes to work with the PCP, if she is not going to be supportive, then I might want to look into a new doctor or just see the surgon's office for any issues or concerns.

I have my physical exam on Jan 10th, which I am really excited about because I have a lot of questions regardin insurance. I was hoping that I might find some advice on here as well...

My issue is that at the moment I am between 38-40 BMI (my scale broke so Im not quite sure) but I do have high blood pressure. Ive only had HBP for about a year, maybe a little more, and Ive never had a BMI of 40 (maybe when I was 13 and first diagnosed with hypothyroid). My BMI has always been around 35 and sometimes lower, although Ive been overweight since age 11. I am 5'5" and I havent been under 200lbs since I was 21. I am now 30. I am afraid that my health insurance wont apporove me since Ive only had a BMI of 35 or higher and a comorbidity for 1-2 years, but a BMI of 35 or more for 5+ years. Any advice as to whether its a good possibility that I will get approved. My surgon expressed that for his requirements I do not need to have the comorbidity for 5 years, but Im just worried about insurance.

This is what my insurance states (I have Excellus Blue Cross Blue Shield - Simply Blue and I am in Rochester NY):

A: Patients must be morbidly obese, which is defined as either having a BMI greater than or equal to 40 kg/m2 or having a BMI greater than or equal to 35 kg/m2 and existing comorbid condition(s) (e.g., hypertensive cardiovascular disease, coronary heart disease, pulmonary hypoventilation, hypertension, hypercholesterolemia, dyslipidemias, diabetes, sleep apnea, degenerative arthritis of weight-bearing joints, or other weight related arthropathies, and metabolic syndrome). Documentation of the comorbid existing medical condition(s) must be submitted by the primary care physician.

B. The condition of morbid obesity must be of at least 5 years duration.

Hope someone can give me some insight!! I really want this surgery.

Yep

Enjoy the Journey

It can be frustrating at times but its really okay!

I think you got this too. If your policy covers it that the main thing. Looks like that Pcp covered the recommendation basis.

Last thing the hoop jumping/appointments

in the end it's not hard at all.