So as you read, I am a newb.

My name is Mike, I am 34, live in Braidwood , Il, and I am kinda dissapointed.

I received a letter in the mail today denying me of insurance coverage for the band. The letter said I did not meet their requirements. I really laughed at that.

I did all of my pre requisite doctor garbage, and every one of them stated the band was an excellent idea for me. I am very healthy, just 151 pounds overweight, with a BMI of 45.

So now I am debating my next step. What should I do, where should I go from here, that kind of stuff.

Any words from you pros?

Mike

Hi Mike! Wecolme to th lapband land. What exactly did you not meet according to them? I swear, insurance companies can be so picky! Is there any way you find out what you need to do to get the band covered? Good luck and keep us posted.

I plan on calling the insurance company today, to see exactly what I may still need to do. I think I may actually need a doctors referral. I know what you're thinking, it isnt like that. About 2 years ago my doctor recommended the band to me, so after a long thinking process, I went to one of the seminars. So technically I did not get my doctors actual referral.

I'm hoping that's all I need, I can always go see my Doc, and she will gladly referr me

Mike

Mike,

I belong to the yahoo news group called DFW Bandsters. We have a link containing forms for an insurance appeal. Good Luck and Welcome!

Well, I talked to my insurance company. According to them, I didn't meet their requirements in 3 areas.

1.) I have to be 100 pounds overweight, with a BMI of 45 or greater.

2.) I need to have documentation of failed attempts at traditional weight loss.

3.) It needs to be medically necessary. Meaning my weight has to have some sort of life saving benefit, or I must have another underlying condition, sleap apnea or the likes of that.

So they are going to send me out an info packet explaining what exactly I need in order for the surgery to go through.

Mike

Well, I talked to my insurance company. According to them, I didn't meet their requirements in 3 areas.

1.) I have to be 100 pounds overweight, with a BMI of 45 or greater.

2.) I need to have documentation of failed attempts at traditional weight loss.

3.) It needs to be medically necessary. Meaning my weight has to have some sort of life saving benefit, or I must have another underlying condition, sleap apnea or the likes of that.

So they are going to send me out an info packet explaining what exactly I need in order for the surgery to go through.

Mike

HI MIke

I like you was turned down by my insurance company. They sent me to a weight loss dr for six months to be approved for the surgery. Three months into the weight loss dr they sent me a letter and told me they would not cover it. I got so tired of fighting with them, I decided to go to Mexico and have the surgery and finance it thru med choice financial. I had Dr Ortiz do the surgery. It was a great experience and I would do it again in a minute. It was 8500.00. Less than half if I had it done in the states. Good luck with whatever you chose to do.

Mema

Go to Mexico. The price is about half. Many of the surgeons are more experienced than here in the states. Look up Mexico on this sight for more info. Its what I did.

i have also seen that a dr. in denver does it for 9950 or something like that...check it out! good luck-keep us posted!

Well, my doctor just called me. What they plan for me is to come in and reweigh. Only to see if I am at the 45 bmi range yet. I was at 43.9 when I was there a few weeks ago.

Also, they said I should get a letter of recommendation from my doctor to help things out. So I am going to do both, and then just wait to see what happens!

Lets hope I can gain some weight to hit that 45 mark! J/K!!!

Mike, keep the faith. It is worth the wait. Julie

Mike

There are those who advocate rolls of quarters in your pants pockets when you weight...

I didn't qualify for insurance either - according to them, I was TOO fat for lap band. They would only give me the by-pass.

Uh, yeah. Sure. Whatever.

So I fought and won. Get the list of requirements and make sure you have included documentation for each item. Then, if they deny you again, fight. I just don't see why the insurance companies aren't more enthusiastic about providing these surgeries...

It has to be cheaper than open heart... and that is what I was headed for.

Good Luck!

The funny thing for me is, I am a union carpenter. You would think that they would realize if I had the surgery, dropped weight, they would get almost double the work out of me!!!! It just doesn't make sense.

I guess we will see if on monday, when i weigh enough to have a 45 bmi, a note from my doctor relating she recommended this 2 years ago, and the letter also stating any medical issues I have now and what they will cost when I am 10 years older, if they will change their mind.

I think as of now, one can only hope.

Well, time for an update. Since the last post, I went back to the doctor and re-weighed. I ended up hitting a BMI of 45.5, and my weight was 149 pounds over medically recommended.

I had to handwrite an appeal to my insurance, which I did, and I got a letter of recommendation from my general practitioner. I also received letters from the phsycologist, cardiologist, pulmonoligist, and from the doctor actually performing the surgery.

Hopefully my appeal turns the decision to what I want and need it to be. So for now, I am playing the waiting game.

Mike

Well, as of Monday, I was approved by my insurance to be banded. my surgery date has been set for Tuesday June 26th.

I am kinda nervous, but excited at the same time.

I need to do an upper G.I., a blood test, and then do some education class for a couple of hours.

That's not the worst part though. I also have to gain the 11 pounds I just worked off, back. Talk about some garbage!!!

Well, enough for now!

Mike

Hi Mike,

Welcome and congrats on your Surgery date! I wish you the best!

Hi Mike, well that is good news that you have the insurance companies approval. I was denied and I am now waiting for them to reconsider as I sent addtional inforamtion in. I can't believe you have to gain back the eleven pounds. That sure is healthy right before surgery(not).:rolleyes

Good luck to you and let us know how you are doing. I am glad you did not give in to the red tape.