Need some input please!!!

WillPower · November 2, 2004

I am trying to get the approval to be banded. I think that I am going to get the run around. Has anyone had to do a 12 week supervised diet? To be approved for surgery. Now there are telling me that I have to have a Psyche Eval. I am going to have to change my life, I am going to have to control my eating,,,, NO SHIT! I would not be doing this if I could be trusted around food!! My stomach is like a dog, if it is not on a leash it will run and run and run........... They are also trying to tell me that my BMI has to be over 40. when I am at 37.8 right now. I think that this is going to turn into a horror story, maybe I should just give up.

Zoe · November 2, 2004

Hey Will, remember your insurance company is trying to spend as little money on you as possible while extracting the highest premium from your wallet. Check out the insurance threads on the board. Lots of people here have been incredibly frustrated by their insurers -- but they kept fighting. Some of us were so fed up that we decided to pay for the band ourselves rather than haggle with insurance. Some kept hounding their insurance company until they got a response.

Your insurance company wants you to walk away. . . so it doesn't have to pay a cent. Unfortunately for most insurers it's just a financial calculation. Will they come out ahead in the long run if they pay for your surgery? If the company's already shelling out money for you on obesity-related illnesses -- diabetes, high blood pressure, sleep apnea, joint trouble, etc. -- you might have an easier time persuading someone to approve your application.

If you truly believe the LapBand is the right thing for you, don't give up. You will find a way. Good luck -- and let us know what you do next.

Chris S. - L.I. · November 2, 2004

This is not unusual. I think most insurance companies require the diet history some in fact for 6 months. The psch eval I think is pretty standard. I even had to meet with a nutritionist. I was willing to go through whatever they wanted (within reason) to get my band.

DeLarla · November 2, 2004

The psyche eval is nothing to worry about. If you say something like "I'll keep eating till I burst right through the band" then yes, that's a problem. They just want to make sure you're mentally ready, and that you 100% realize that you'll be making lifetime changes. A lot of people think the band is a magic tool. It's not, so that's why they evaluate your thinking, just to be sure you're not going to work against the band.

I have dual insurance (one through my work and another through my husband's.) I had enough stress and heartache already, so I didn't bother fighting with them. A lot of people fight and win, but it takes them a long time and a lot of frustration, but it's almost always worth it in the end.

Most people will say they can't afford the surgery if they self-pay. I say that's bullshit. If I can afford Super-sizing 10 times a week, midnight runs to convenience stores, massive grocery bills, paying hired help to mow my lawn & clean my house since I'm too fat, shopping only in high-priced specialty stores, etc., then I can afford the band. I put it on a credit card with payments around $100 a month. My grocery bill has dramatically decreased, and 7-11 hasn't seen any of my junk food money in months, so my band pays for itself in about 2 years.

As far as your BMI not being high enough, do you have weight related health issues? If you have diabetes, sleep apnea, or any other dangerous health problem caused directly by your obesity, the insurance company probably won't require a BMI of 40.

Last, a lot of insurance companies want you to try one more supervised diet as a last chance before they pay for a band. The band is worth waiting 12 weeks - just get the diet plan and do your best. Nobody expects you to be able to stay on a diet (duh, they've never worked before, why would they now?) but they want to document your file to show you really are at your rope's end.

Good luck to you. Go get 'em!

momhappe1 · November 2, 2004

My insurance asked for past history, more then likely you already have it.. Even been on weight watchers? Does your doc know that? Also my BMI was under 40 and I got the same thing. I have been working on this for 1 year. I finaly got it. If you are under a BMI of 40 and do not have a morbid disease. I did not have one, they turned me down. So I thought that I might have sleep apnea, and guess what after going through all of the testing I did. You more then likely do if you are over weight. As soon as I got my results I sent them to the insurance co and they approved my surgery with in two days.

It all depends on how bad you want it. I am a single mother and there is NO way I could have paid for this on my own.

Good luck !! If you want it, just keep on trying, you never will know if you do not try.

momhappe1 · November 3, 2004

I knew I posted on this one already. There are two of them..

blossom · November 3, 2004

WillPower, I know how much you want this so please don't give up. It sounds like you may have to fight your way through this, but it will be so worth it in the end. My BMI is 38, but I have high blood pressure and back trouble. Also, I have a lot of heart problems and such in my family history, which I documented for my insurance and also made sure it was mentioned in the letter of recommendation from my PCP. Have you ever been on a dr supervised weightloss plan? If so, be sure you get a copy of your records and document all your other weightloss efforts, as well.

I know the 12 week diet is crazy, but if that is what they require, then do the best you can and just get through it. I am currently on a liquid pre-op diet, and I just keep thinking, If I could be successful with this diet, I wouldn't need a lapband, now would I? DUH! But that is what my dr required so I am struggling along. That doesn't mean I haven't cheated though, LOL!!! You can do this, I know you can! Be strong and stand up and show those SOB's what your made of! :devious