Hello. My name is Michelle and I am just starting this process. I went to the first seminar last night and will schedule my consult with the surgeon in a few days. I have BCBS of California.

My question is...My BMI is 36-37. Im 5ft 4.5in and weigh about 218. I have a past history of gestational diabetes, preecclampsia, infertility, suspected PCOS, and hpertension. I also have back/hip/feet pain (which I have never seen the Dr for but have had problems for years), abnormal or absent periods and I think my blood sugar is out of whack. I have tested it at home randomly and have gotten several readings in the 140's and once at 192. I go for bloodwork next Wed. I also have a family history of diabetes, uterine/cervical cancer and hypertension. The problem is, none of these seem like huge red flags and I have never been treated by a DR for any of them except the pregnancy related ones. Im afraid that my insurance will deny me. Any thoughts or advice?

Thank you!

I am actually pretty similar to the original poster. MY BMI is under 40. I am considered prediabetic and I have PCOS. I did get approved by insurance, though, but that may because I have a very heavy family history of diabetes, heart disease, high blood pressure, and high cholesterol, among other conditions.

I think you just need to try and see.

According to the surgeon's office I called, PCOS is a comorbidity. I would definitely go to your primary doctor and have tests run for anything conditions you suspect you have. Also, my doctor told me that if I lost weight, I would not have PCOS, so I think the lapband surgery probably will help with hormonal issues. According to a lot that I have read, obesity does cause hormonal issues.

Good luck with your journey.

Cool. I did mention that I suspect I have PCOS but she wanted to see what this round of bloodwork showed before we went that route. I was afraid that if it was confirmed that I have PCOS, that they would put me on glucophage and call it good and deny the lapband. So now that I know it would look GOOD to have PCOS, I will definitely request testing. Thanks so much! Who knew I would be looking for things to be wrong w/ me! LOL

OK, just got back frm the DR. She was awesome and is helping me all she can. My bloodwork she ordered was a lipid panel, hemoglobin A1C, metabolic panel (including fasting glucose test), thyroid, liver functions, CBC. So we shall see what comes of it all.

She was definitely concerned w/ my sugars being out of normal range. WE are waiting of the PCOS testing for now...

Oops, meant to post this before the previous one, I had 2 reply windows open, typing in them both!

It would be nice if things that could contribute to weight gain were considered as well as things which can be improved by its loss. I had no problem getting approved- my BMI was 43 and I have hypertension and GERD. But I know there are conditons that are at least correlated with obesity (narcolepsy is one of those). While weight loss won't help those specific conditions it does help overall health and helps prevent more problems from occuring. I know hormonal issues might also be that way, etc. Seems like a bit of a catch 22.

I disagree. Anytime your sugars are consistently out of range, it is a cause for concerne. LMJ needs to have her bloodwork done and find out her A1C. If she's 6.0 or higher, it's a comorbidity and if she has hypertension as well, she should be covered.

You misunderstand. I am referring to the insurance's co's view regarding WLS. Yes, it is a concern for the OP but not in the insurance co's mind. It doesn't mean they will cover the procedure.

The hypertension is not a diagnosis and she is not receiving treatment (as I recall, I've been out of town for a few days and I'm going by memory). I am referring to insurance covering WLS. Thus far undocumented, unproven comorbidities are not issues an insurance company will see as reasons for WLS.

I got my results today and the only thing that came back abnormal was my cholesterol. So I officially have hyperlipidemia. I put a call in to my GYN to call me Monday and hopefully we can start testing for PCOS..

Before you read this please remember that I am NOT an insurance expert!! I'm just going by what some of our patients have dealt with regarding general insurance issues, I don't work in the field of bariatrics so I'm not referring to bariatric patients.

Diabetes vs. pre-diabetes. I have two friends that have been banded and they are both pre-diabetes. One has PCOS. Insurance required full blown diabetes in order to be a comorbidity. BTW, they were both self pay for their bands.

If you get an official diagnoses of pre-diabetes and let's say you don't get approval for the band because it isn't full blown diabetes, will this diagnosis now exclude you from getting coverage at a later time for a future insurance? This would be a question for Alexandra. I don't know the laws regarding this.

What are your fasting blood sugars? That is more what insurance is going to be looking at along with the comparison after you eat something.

We had a patient a long time ago that suffered from Munchausen Sydrome. She would fake illnesses in order to get the attention from diagnosis and treatment. She would come in NOT fasting for a blood sugar test and she came back mildly high. Then we'd have her drink glucose and her blood sugar did not reflect the additional sugar. In her case it was easy to demonstrate what she was doing for a variety of reasons. Point being, pre-bandsters get pretty anxious about getting the band and they do all kinds of strange things such as gaining weight to meet a required BMI, etc. Don't try to fool anyone with your blood sugars because it won't work. We need to find another way.

I doubt anyone will do anything other than to tell you to watch your diet, watch your caloric intake, and exercise for any blood sugars below 200 after food.

I can't see how hormonal issues would be a band issue. You would likely have those same issues as a thin person.

Reflux... you might have something here. You have to demonstrate that you have it but the more important issue is why. If you have a hiatal hernia THAT is something you can work with. Many obese people have them as often times obesity causes them. The key here is that if you do have a hiatal hernia you can have insurance pay for the OR, anesthesia, etc. to repair the hernia and then self pay for the band itself. The incisions for a hernia repair and the band are exactly the same. Most docs will fix a hernia while the place the band. See what I'm talking about? Let insurance pay for everything but the band itself. You may have to self pay for the band and the additional doc time to place the band. Much cheaper than paying for all of it. However, the band is $2K in Mexico and an OR person was just posting yesterday that the US cost for a band is $4K. Then surgeon fees on top of that.

sleep apnea... just waking up a few times isn't sleep apnea. But you could try to get insurance to pay for a sleep study to see if anything is there.

Joint pain... you'd have to demonstrate on xray this is weight related. Do you have arthritis? Degenerative joint disease?

Honestly, I'm not seeing how you would possibly meet the requirements for insurance to pay for banding.

Hi. I was just wondering how Sleep Apnea affects the banding process. I just recieved a message from my pulmonologist that I missed....that my sleep study came back that I have sleep apnea and wont be able to have surgery till this is treated? How is this treated and how long does it take to treat? Does it go away after treatment or is this a lifetime daignoses and need to be treated with intervention lifelong? Why would this put off the surgery if we know it needs to be treated and begin treatment?? how long after the onset of treatment before surgery can be done??

IF anyone has information on the above..would love it before approaching doctor tonorrow.

Thanks....Jodi