want lap band but afraid I may not qulify

disneyfan · July 2, 2007

Hi, I am 39 yrs old. I am 5'3 and weigh 205, so my BMI is 37. I have hyopthyroidism and high lipids. I have a family history of heart disease. My mother is bed ridden from being so morbidly obease. She has not gotten out of bed in over a year. She needs a caregiver to put her on a bed pan, give her baths and do everything for her. My grand parents were very obease. My siblings are also very over weight. I want to take care of this now before it gets anymore out of control. My sisters are 4 and 5 years older then me and I see where I am headed. I am so ready to take control but I know I need help. I have done weight watchers, nuti system, diet pills....I have BCBS of IL. I looked in the guide book and it doesn't say that it is not covered but it doesn't say that it is. I am going to call them tomorrow morning. What do you think? do I have a shot of getting the surgery covered? Thank you for listening to me.

alex10 · July 2, 2007

I'm pretty new at this--hoping to have my surgery at the end of this month. But based on everything I've read, it sure sounds like you should get the surgery covered. I have BCBS NC and my doctor says he's sure I'll be covered. MY BMI is higher than yours (39) but since you have those health issues, I think you should be good. If you can come up with a few more problems that would be helpful--back pain, pain in your feet, shortness of breath?

mattintosh · July 2, 2007

I'm pretty new at this--hoping to have my surgery at the end of this month. But based on everything I've read, it sure sounds like you should get the surgery covered. I have BCBS NC and my doctor says he's sure I'll be covered. MY BMI is higher than yours (39) but since you have those health issues, I think you should be good. If you can come up with a few more problems that would be helpful--back pain, pain in your feet, shortness of breath?

Its less than a used car. At getbandednow.com its only 8500.00 with their financing and tax deduction thats allmost one third off! How can you not get this!

disneyfan · July 2, 2007

Thank you for the reply. I was worried because I read that you needed a bmi of 40 and be 100 pounds over weight. At 205, I would need to lose about 75# and my BMI is only 36 not 40.

WASaBubbleButt · July 2, 2007

Its less than a used car. At getbandednow.com its only 8500.00 with their financing and tax deduction thats allmost one third off! How can you not get this!

Anyone get the feeling that somebody works for getbandednow?

WASaBubbleButt · July 2, 2007

Hi, I am 39 yrs old. I am 5'3 and weigh 205, so my BMI is 37. I have hyopthyroidism and high lipids. I have a family history of heart disease. My mother is bed ridden from being so morbidly obease. She has not gotten out of bed in over a year. She needs a caregiver to put her on a bed pan, give her baths and do everything for her. My grand parents were very obease. My siblings are also very over weight. I want to take care of this now before it gets anymore out of control. My sisters are 4 and 5 years older then me and I see where I am headed. I am so ready to take control but I know I need help. I have done weight watchers, nuti system, diet pills....I have BCBS of IL. I looked in the guide book and it doesn't say that it is not covered but it doesn't say that it is. I am going to call them tomorrow morning. What do you think? do I have a shot of getting the surgery covered? Thank you for listening to me.

I'm no insurance expert but it seems to me that you might have a rough time getting insurance to pay for this. Usually you have to have a BMI of 40 or more, or... you need to be at 35 with specific comorbidities. Something like joint damage from weight, hypertension, etc. Call your insurance company and see what they say. But I have a hunch you might be on your own for this one.

Rhonda39 · July 2, 2007

I think that the first thing you should do is call your insurance company. If you have any questions on what's covered and what's not.

That's what I did and found out that its covered with what I have now, but in December my coverage is changing to Aetna. I called Aetna and gave them the company's group number to see what's covered and what's not. I'm hoping that I can get this completed before December when my current coverage changes. I also told my current doctor's that my coverage is changing in December and if there was anything that they could do to hurry the process up. So far I had the second apt. before my mother did, and we went to the same first apt. She just got her second apt for Aug. 29th. I'm going to try and call them tomorrow and see if they have any further information on when I can have the next apt. I'm trying to loose enough weight before hand so I wont have to starve my fool self for the last stretch of this process. Its also been a long process, but I'm hoping to see the light coming soon.

Take care and good luck with everything and please keep us all posted on how things are going.

disneyfan · July 2, 2007

Oh, I hope you can get your surgery done before your insurance changes!!! Why would it take so long? I don't understand, if you quilify why wouldn't it be able to be done before Dec. I hope it works out for you!!!

faithmd · July 2, 2007

Disneyfan, many insurances have qualifications and requirements. I qualified with my insurance with a BMI in the 50's, but I still had to meet their requirements which were 5 years of being 100+ lbs overweight, 12 month MD supervised weight loss program, and monthly visits during that time, miss a month, start all over again... I was also required to lose 5% of my excess weight.

juliegeraci · July 2, 2007

Hi Disneyfan, sounds like you are doing everything right. Check with them to see what your BMI has to be. Mine was 40% so I was okay. If your BMI is too low sometimes they will take you based on other symptoms of obesity. Good luck to you.