Hello everyone. I am new here to the forum. I was recommended here from someone at the 3 Fat Chicks Website. I am here obviously because I need to lose weight.

I am 22 years old, 5'4 and weight (I'm sure) over 305 lbs. Back in April 2003 I started a weight loss program, and successfully lost about 50 lbs. Then after August 2003, I started eating "normal" again, but I was still exercising daily - and I gained back ALL of the weight, plus a little more.

I am miserble. I have tried every diet known to man, and nothing has worked. The last few weeks, I've just felt like I'm doomed to spend my life fat.

I don't want to live like this. I am young. I should be out having fun. I currently cannot walk long distances without becoming very short of breath. I have chest pains every day. I just found out a few months ago that I have high cholesterol. Imagine that! 22 years old, and high cholesterol! That's crazy! And it's scary!

Last night my sister asked me why I wouldn't consider surgery. After I thought about it - I realized that I don't have to have Gastric Bypass surgery. That truly scares me. But I remember hearing about the band.

So I am here today to find out about the band. Any information that you could provide to me would be greatly appreciated. Here are a few questions that I have.

How long has the band been around?

Where do you begin with trying to get your insurance to approve the surgery?

Is the surgery difficult?

What is the recovery time?

What are the complications?

Have there been any severe complications with the band?

What is the recovery time?

Is there an "average" weight loss?

Any other information that you may be able to provide me would be greatly appreciated!

Thanks so much, and I look forward to getting to know many of you!

~ Kari ~

I guess the thing that worries me is the "Not Medically Necessary" part. All the insurance co. has to say is - is that this is not medically necessary.

Kari, the good news is that just about every state in the Union understands that MEDICAL decisions shouldn't be made by your insurance carrier. It's your DOCTOR'S place to make the "medically necesary" call, not your insurer. Sure, they might say he hasn't made the case sufficiently to convince them to cover surgery, and that's their right, but then all the doc has to do is supply more information.

The American Medical Association has published guidelines on diagnosis and treatment of just about everything, and doctors and insurers rely on those guidelines. According to the AMA, Morbid Obesity is DEFINED as a set of conditions (BMI over 40, or BMI over 35 accompanied by two co-morbidities) that if present, require treatment. That's why you often see exclusions worded as I described earlier. So, if you have the condition--and that diagnosis code of 278.01 is present in your record--you really can't be told treatment is not medically necessary.

I think you're in very good shape, insurance-wise. Get thee to your primary care doctor for a physical as soon as you can and open the conversation about bariatric surgery. Your carrier might very well require evidence of prior dieting experiences, or at least one more attempt at a doctor-supervised diet of six months or so, but nothing will ever get off the ground unless you get that physical.

Keep us posted!!

Wow - thanks again for the replies. You are ALL wonderful, and supportive!

I think monday will be the day that I call my insurance co. and see if they cover this surgery.

I will definatly get in with my doctor, and see about getting a physical. I haven't had one of those in a loooong time...lol.

Oh - I also wanted to know.... how do you know if the doctor will put the 278.01 code on the paperwork? Do you have to ask him to do that?

Luckily - if my insurance co. needs some type of proof that I have been on "diets" ect... I can give it to them. I *should* be able to get the records from the Medical Weight Loss clinic from back in the mid 1990's. And I should also be able to get the paperwork from a year ago when I was attending their program. Also - this past summer I signed up for the L.A. Weight Loss center, but quit two weeks later, because I was so discouraged about my weight. I should be able to provide them with that paperwork too.

I used a BMI calculator today, and found out that my BMI is 53!!! Sheesh. I feel so yucky about that. How I let myself get this far out of control - is beyond me! Now it's time to try and take control of my body!

Thanks again for the replies. I will call the insurance co on Monday - and let you all know the outcome of everything!

~ Kari ~

Kari,

My insurance changed with my job in July of this year. I had been on Blue Cross of WY and when I called to ask them if they covered it, they said they did cover the bypass, but to submit reasons why I wanted a lapband thru my doc. That claim was denied, but by then, I had new insurance with Beech Street. I called Beech Street several months before I was even a member and asked if they covered weight loss and they said YES. I asked if they had ever covered any lapbands, and they said they had covered several in the last few years. I got approved with MINIMAL hassle! They were awesome. Then, my employer sent out our coverage booklets, and weight loss was listed as "excluded" except with medical necessity to be proven. I had to show a medical history, a medical supervised diet (I had done phenphen about 10 years ago), and had to get a psych eval. That was it. Honestly, that exclusion paragraph would have discouraged me had I not been approved! SO, all this means, YOU JUST NEVER KNOW!!! Go for it. I even had a friend who paid big bucks to BC/BS for 6 months on high risk insurance so she could get a bypass...and they paid if for her after 6 months! SO, there are ways around it, too, without being stuck with the whole cost.

I would just call and ask about a coverage claim and see what happens. All information is good information!!!

As for your other questions, I had surgery on Tues in CO and I am tired today, but no pain meds needed...just sleeping and taking it easy! It was honestly much easier than I had prepared for.

Good luck!

Rose

Hi Rose - congrats on getting banded! Glad to hear that everything is going well for you so far!

I am feeling more and more positive about this. I get a little nervous about the whole insurance thing, but I know I can fight it. I'm strong lol.

Please keep me updated on your progress Rose! You'll be feeling great in no time at all!!!

Thanks again!

~ Kari ~

Kari, when you're at your doctor's for the physical just tell him or her what you're hoping to accomplish. With a BMI of 53 you really won't have any problem meeting that medical-necessity yardstick, and if you tell your doc to give you the diagnosis I promise you he or she will.

The code may not actually appear on anything YOU read, but if your doctor is an in-network provider his office will have to code everything in order to get paid. Just mention that you definitely want that code and/or that diagnosis in the insurance record.

Thanks Alexandra

I will be sure to do that. Could it also help if I give my doctor a copy of my medical records?

I just got my health insurance back on the 1st of July - and have only seen the doctor once. (And this is a new doctor - no one I've seen previously).

The last time I actually went to my family physician - I was 18 or 19 years old. Now my physician no longer there due to his own health reasons.

Can my new doctor even keep my old medical records? Just curious if this would help me out too - seeing as my weight has always been an issue since I was little.

Thanks again!

~ Kari ~