Hi everyone!

I am in unfamiliar territory here, so be nice :welldoneclap: .

I have done a LOT of research on the Lap Band procedure, and have heard only a few stories of low BMI patients being insurance approved for the band. I am currently 4'11 and i weight roughly 168-170 pounds (depending on what time of the month i weigh in) and my BMI is currently 35.3 & I want to get banded. I have struggled with my weight for 8 years now and at a recent dr's appt, i was warned that If i keep gaining weight at the rate i am ( about 6 to 7 pounds per month) i risk developing diabetes. I have contacted Dr. Carter who's practice is in Arlington, Tx to see if he thinks i am good candidate for the band. There are asking for LOADS and LOADS of information and documentation in order for me to get approval. #1 problem, I do not have a PCP i usually use my ob/gyn as my primary health care provider, and i usually only see her once or twice a year. She has never truly monitored my weight nor has she supervised any of the numerous diets i have attempted. Is there any other way for approval that you guys may know of? I am getting down right desperate here as i don't want to have to wait another 6 months to a year to have my op. :help:

You MUST start with your insurance company and sadly you really are going to have to jump through their hoops. If you are able to go the self-pay route then you may be able to skip over many of the requirements that the insurance company puts on you (like BMI, etc). My insurance company will pay at a BMI of 35 with TWO comorbidities. A good doc or surgeon can help ferret out comorbidities and get them documented (like a strong family history of diabetes or heart disease, there's two right there). But to do that you must see those doctors. My insurance also is very strict in a 12 month MD supervised weight loss program, and only office notes will suffice. NO LETTERS allowed from the MD, it must be progress notes. Of course not all insurance is as strict as mine, but very few would approve you with what you have at this point. Your first call needs t be to your insurance company and ask if they cover the band, and what the requirements are, then get them to send it to you so you'll have it in writing. In the meantime, ask around and get a name of a good PCP, or get names from your insurance company of who is on their list, then call thos offices and ask the staff if the doctor is pro or anti-WLS. Then make an appointment with one and start going every month. Start tomorrow, the sooner you start, the sooner you can get banded.

Here's a link to the Lower BMI bandster thread, there's lots of good info here:

http://www.lapbandtalk.com/lower-bmi-bandsters-t26697.html

Good luck and welcome!

FaithMd,

Thank you soo much for all of that information. I am still in the beginning stages of getting everything in place and it has been a nightmare. I have my first consultation on Mar 29th, the surgeons office referred me to a great PCP who says that due to my family's history of heart disease, type I & II Diabetes, heart attacks, strokes, hypertension.....etc that I am a very good candidate even with the lower BMI. I am staying hopeful, and am wiling to jump thru the hoops to have my approval, i am detrmined to stop at nothing, and as a very last option will try to finance the procedure. I have pretty good credit so that shouldn't be so hard. Even though this may sound crazy, my insurance company has denied me for EVERYTHING, even my infertility treatments so i want them to pay for SOMETHING otherwise there is no point in me even having insurance if everything is going to be paid out-of-pocket....is that a horrible way to feel? Regardless I am going to stay focused and do what i need to do for this approval, I will keep you posted.....again thanks for all the info.

p.s. how long does this process usually take between inital consultations, approval and getting banded?

Have a great day!!

Hopeful bandster

FaithMd,

....is that a horrible way to feel? Regardless I am going to stay focused and do what i need to do for this approval, I will keep you posted.....again thanks for all the info.

No, I don't think that's a horrible way to feel at all. If we're paying for insurance, they should be paying for something, too! And please do keep us posted.

p.s. how long does this process usually take between inital consultations, approval and getting banded?

Have a great day!!

Hopeful bandster

Ah, the magical, elusive question...No one knows... REALLY, no one knows. It all depends on what your insurance requires (call tomorrow-if they require a six month diet, then you will be waiting at least seven months), if there is no insurance requirements, then it depends on what your surgeon will require: do they want a psych consult, cardiac consult, sleep study, etc? Those things all take time to schedule and have done. If none of those things are required, then it is all up to your surgeon's office and how quickly they gather the necessary paperwork and submit it, then how quickly the insurance approves it. I've read of some people who waited three months for the insurance approval, and others who knew in a week. See why it's so subjective? So get cracking and keep us updated! :welldoneclap:

I live in Arlington too.

I started going to AIGB in Hurst and they helped me with all my paperwork for insurance. THe staff was great. It really seemed effortless on my part, except for all the food/exercise journals. My insurance required 3months interdisciplinary diet (medically supervised). I didn't even tell my PCP, I used my weight history from my ob-gyn. In all it took me 4 1/2 months to get approval. I am not a low BMI like yours but with you family history hopefully it will all work out.

Best of luck! :welldoneclap:

Skinnyjeans,

That's exactly who I'm going thru, AIGB in Hurst. I am so glad to hear you say that's who you are going through. Yaay!! A huge weight has been lifted now because i was not sure what to expect from them. If you don't mind may i ask what insurance compnay you have? What type of studies or test did they perform on you, and exaclty how may visits did you have to schedule? I know this is alot of questions at one time but i am trying to make sure i am well informed, so i know what to expect.

Thank you so much all of you for the help and support.

Want2get BAnded,

I have Aetna POS. I called them and found out what my insurance covered. AIGB knows the insurances pretty well and will help u get qualified.

I had to have 3 visits there exactly 1 month apart (the first consult doesn't count as the first visit). Then I had an EEG test. I was already on a CPAP machine, so didn't go thru the sleep study there. I also needed 3 visits with a nutritionist. I used Leah McDaniel (on the list AIGB gives you, plus she accepted my ins. so was only out copays) She was great and helped me visualize how much I would be eating after surgery. Then before my last visit, I had all my preop bloodwork completed. It was right around the time I would have had my bloodwork done with PCP, so ins. covered it also.

I have recommended serveral friends to AIGB. They just made everything so easy. When I read over all the paperwork my Dr. wanted, I felt overwhelmed. Flora, Maria and Amy were all so pleasant.

And after surgery you can go there for the aftercare program every 3 months, to talk with a nutritionist and let them know how everything is going.

:clap2: I also went through AIGB in Hurst, The insurance I had at the time of my surgery was United Health Care, once I went to the Hurst office it was around three weeks and I had an approval and my surgery was schedueled within two weeks I do not have a low BMI but maybe as skinny jeans said with your families history you might get approved. Best of Luck, I was banded 9/13/06 and as of today I have lost 60 lbs and going down:faint: :faint: :faint: :faint: :faint: :faint: :faint::faint:

Thank you both so much, i feel alot better knowing what i'm in store for. i am truly hoping that with my families medical history all will be good.....i will update regularly as to what progress has been made..... who knows i just may have good news to report.

Good Night All, and thank you for replying to my thread!

Here are a few things I did on my own. You need to make sure you doctors will write letters to the surgeon telling why they think you are a good candidate for lap band. Think of any symptoms you have that "may" be attributed to being over weight. I have bad knees and a bad back. I asked my orthopedist if they "could" go away with weight lose and he said yes. He wrote me a letter saying that. I have regular period and stress urinary incontenace which if you say you have they take your word for it. Not something they examine you for. This is when you sneeze or cause you can have a little urine leak. So my gyno sent a letter saying that my irregular period and stress urinary incontinence "may" be fixed by losing weight. I have started snoring and cant sleep very well. I had a sleep study done. They said that I have "slight" sleep apnea. Losing weight "may" help this. I have shortness of breath when exerting myself. now high blood pressure. This is do to my anxiety and my anxiety meds help it. My doc just wrote that I have high blood pressure, they don't ask what it is due to. I hope I have covered everything that go me approved. The main thing is getting all you duck in a row as my husband would say lol. Start making all these doctor visits on your own before your consult. You can have the visit tell them you are considering lap band and then when you need the letter you can just call the doc since you have already seen them for this problem. If you are worried about the 6 month diet. They just want six months of your weight being recorded. I was lucky I had seen my doc every 3 months for a while do to my anxiety, but every time you see your doc they weigh you. when I wasn't sure if I was going to be approved I was sure to see my doc once a month and when making the appointment I said it was a follow up on weight loss so I could get the appointment easily. Once you have done all that you need write all your appointments down on a calendar. This was my g-d sent. For example- my psych eval letter was holding me back it hadn't been faxed over. I call them on feb 20th and say" I am looking on my calendar now and i see i had seen the doc on feb 1st and i am still waiting for this letter. They called me back and said he is working on it right now. Yeah right he probably forgot about it. back to the psych eval make sure when you are talking to them you let them know you know that the lap band is only a "tool" and you are willing to work and do the rest on your own. i had a friend fail the psych eval for not making that clear enough. back to the letters. Make sure you get to proof read them for yourself. My primary doc who was the one who had so much important information in hers wrote that I was 26 not 27. to me that is a big deal so I'm sure to the insurance company it was. through this process the woman that was working with me at my surgeons office who I spoke to like everyday to follow up on the letters had kept my "date" open for me. April 2nd. This was like the most important part for me since my vacation from work started that day and I wouldn't have to miss any work if I did it this day. Well, while I was waiting for all these letters so I she could finally submit everything for me to the insurance company she told me that my surgeon was going to be away that day. OMG THAT DAY I FREAKED. Anxiety attack at work while the kids in my class were playing recess. I had to have a kid bring me my water and my "purse". Had to take my meds that I hardly ever have to take. The woman said I have everything and I am submitting everything to the insurance company. I still didn't know what my date would be though at that point I would have taken any surgeon in the practice. Next day on my lunch break after all that freaking out, I got "the call". It was Laurie the woman from my surgeons office. She says "hi, what are you doing" I was like "eating lunch?" She said "how are you", I said "good, and you". She said "good, is march 30th ok for a sugary date"? (that would mean I would only have to take one extra day off of work and I would have my surgeon). I said it was great. Then, said says" oh, and you are approved". I told her I loved her lol. I have the empire plan as my insurance company and it only took two days to approve. I hope this stuff helps someone.

SGDODGE06

WOW!! You really did have your ducks in a row. That's the kind of organization I need in my life...lol. I did finally talk to my ob/gyn (whom i have been going to since i was like 12) so she has all of my weight history, which is great. this past 1 1/2 i have been maintaining a weight around 168-170 but she states my highest was 202 in 2004. she says that this may make it a bit harder for my approval b/c the insurance company will look at it like "yes we know she is able to take off the weight and maintain it if she quits stuffing twinkies in her mouth when she's bored" which honestly is sooo true. she "GASP" thought that i should probably GAIN weight over the next six months and then get serious about the Lap Band. Since she has so much history on me and i've been seeing her for so long I was somehow able to keep my feet in the stirrups and not swing them around to her chin :clap2: but in the back of my mind I'm thinking.....is this woman crazy or what? I refuse to gain weight for this surgery. I'm already unhappy enough with this weight, why would i intentionally gain more?? would rather self-pay than gain weight. Does anyone else think that this was inappropriate health advise??? Due to that comment I am thinking about throwing away a medical relationship over a decade long!

Oh no, I wouldn't throw away such a good relationship over that. Many docs suggest gaining weight if you are close to being approved, in order to put you over the top. I think they do this because being a self-pay is such a hardship for so many folks. Having a bit higher BMI helps as far as the insurance goes. Did she know you would rather self pay than gain? Most times our MD's don't know this unless we tell them. I think she was just trying to be helpful.

FaithMd,

You are so right, after I've calmed down and thought about it (and got a stern talking to from my fiance ) I realized it, I am just very thankful that I did not show her how upset i really was. That would have been a huge apology i would have owed.....i just - i don't know, seem to get so tense, frustrated and irritable so easily these days and i have no clue where it's coming from. I'm guessing fear of the unknown. i try not to think about it for fear that this band will run my life, but it just consumes me. When i tell people i'm considering this surgery they all look at me like i'm crazy and say things like "That's too extreme" or "you don't need that just diet" .... well if i could "just diet" i wouldn't be considering this in the first place. No i may not be as obese as many others who have gotten this surgery but that's where I am trying not to go (hope i haven't offended anyone here).

i have my blood work scheduled for this coming up wednesday and my initial consultation with aigb thursday. everything seems to be in order, i was able to get a letter of recommendation from my ob/gyn (even though she doesn't think i need it, she basically did it for me b/c she saw i was so determined and she wants the best for me....luv her) which is really great. I must say that this forum has been so much help to me, i have gotten a LOT of good information.

I am so glad to have helped you. PM me if you have any questions you think I may be able to help you with as far as the ducks go lol

quack quack

Susie

you could always go to mexico like i did last month and dr. ortiz is doing it for 6800 which includes everything but airfare. and no hoops to jump through. I have a bmi of 32. I bypassed all the crap and just did it. dr. ortiz is world renowned and it was a nicer surgery suite than any in the us.