well i went on tuesday to talk to the surgeon about having the lapband and i had my hopes up verry high but when i got there everything went down i was taken back and weighted and i had lost a few pounds and i was very happy well when the lady started talking to me she told me that for my insurance to pay for my surgery i had to be 200 pounds over my idea body weight and i liked 13 pounds of being there i was so hurt and mad i could have screamed or died i started to cry like a baby and ask them if there was no way around with the health problems i already have i did call the dr that did the referrel to see if he could call the insurace company for me but i would not gain the weight on purpoes but you know the holidays are here and i mean not watching it would not be hard i want the surgery or i am afraid i won't be here to see my little girl grow up :help::embarassed:

Hi there,

I know it seems difficult right now, but have some faith. I've gone through the same ups and downs, and it finally dawned on me that I have to do the leg work to make sure everything goes through-from paperwork to meeting with nutritionists, psychologists, doctors and insurance coordinators! Alas, anything worth having is worth fighting for-so you've got to keep pressing on and fighting for this if it is really what you need/want to stay healthy and see your daughter grow up. It's hard, but keep fighting until you get what you deserve. No one has the right to take this away from you, especially since you're doing it for a better future!

Best wishes, and good luck!

Maribel

I have heard people with these problems before, I have heard about weighing your pockets with rolled quarters when it comes to weight time.. and heavy shoes..

Hopefully someone else who dealt with that will come by and let you know what they did.

I wish the best for you!

oneangelinva,

I've been doing this dance for 5 months to get past insurance. I have to have either 35+ bmi with at least 2 cormorbitites or 40+bmi with no cormorbities. At my first appt in August I was 37 bmi.

There are those people that think its silly to gain to have surgery, and they may be right. But I feel like wls is still needed because I know where I'm headed with my health, all I have to do is look at my mother and grandmother. For me, I don't want to be them in 20 years.

My dr told me not to lose any weight. Then, the problem of not having any major health problems was going to put a dead stop to wls and my insurance paying for it. I'm fat and have fat related issues, bad knees, back, depression, etc but no cormorbities that the insurance would consider...according to my dr, sleep apnea, high blood pressure, diabetes and one more( I'm drawing a blank to the 4th one) , are the top 4 that the insurance co. looks for. For me the only option was to have a 40bmi documented at least once during my 6month supervised visits. They really want you to lose weight those six months and start the lifestyle changes that you will have with the band but I quit smoking and my dr said that midwesterners(I'm in Missouri) generally gain an average of 7lbs over the winter, plus I had a change in medication....:heh:....so, I started reading others stories and researching and found that people cheat, they weight themselves down.

I'm not a dishonest person and if I hadn't read others stories I never would have done it. At first I tried to eat my way to the 12lbs I needed to get a 40 bmi and was miserable, it was only fun for a little while. I pretty sure a lot of bandsters have been up and down all their lives and it totally sucks that the insurance co doesn't take that into consideration.

I added ankle weights and depending on what you wear, you may be able to add weight in you pockets. My insurance may still deny me but I'm meeting there requirements for wls that I know I need. My mother and grandmother have diabetes, my gran was diagnosed with heart disease, my mom has had a hip replaced, etc....I simply can't do it on my own and I know it.

I was a little scared to post this on the board because I don't want others to slam me with critisms, but I wanted to let you know you are not alone. You have to keep in mind how cool your dr is about it. I'm lucky enough mine knows its an insurance game and the weight issues have been for my lifetime up and down. For me I couldn't let 12lbs that I lost over the summer stop me.

Good Luck:girl_hug:

Hmmm

I wouldn't recommend gaining weight (and are you sure it's 200 lbs? Most programs are 100 lbs or 40 BMI). However, I wonder if maybe you aren't an inch or so shorter than you think you are? Because, you know, shorter folks have lower ideal body weights, and my doc never pulled out a tape measure when he asked my height and weight. Just some musings....

I say, if you need to add weight, then do what you have to! It's really stupid that the insurance company doesn't want to pay anyway. I was very fortunate that my insurance did pay. But, then I WAS 100 pounds overweight. I like the suggestion of adding things to your pockets or ankle weights. Would be MUCH healthier than actually gaining the weight they require!

Though I've heard people weighing themselves down successfully, what does your doc to do weigh you?

At mine, I would have had a hard time. He's made me take off my coat, and you never get weighed with shoes on, you have to be bare foot so the metal in the bottom can calculate something about fat.. or whatever. And they did measure my height with something they have on the wall. Sounds like a lot of people don't have to do all that though. I'd opt to weigh myself down before gaining even more weight. Of course, if my insurance would pay it if I just gained 13 more lbs, I may have even done that too. Would have saved me a lot of money & headache!

I agree, it depends on what you can get away with.

My first visit the dr checked my ankles for swelling, but the further into the appts I felt more comfortable adding ankle weights because he didn't do it after that first appt. I just came right out and asked how many times I had to be documented as 40bmi, once??, he said yes so I slowly added. I hit 40 this month and will maintain next month just to show I didn't gain any and have that 40bmi documented twice.

Flared jeans or boots can hide a lot, and I weighed my shoes to get the heaviest pair.:heh:

If it were me I would gain the 13 pounds, as is I barely make it..If I lost 13 pounds now I would no longer qualify...

Best wishes with your decision making

Personally speaking I would gain the 13 lbs and say the hell with it. You will lose that the first month being banded. Hope you get the surgery! Julie

I think you should call your insurance and find out what they have to say about it. If you are almost 200 lbs above your ideal weight, than I would bet almost anything your BMI is above 40, which is usually the higher end of what insurance requires to cover the surgery.

Check with them before you base anything off what the nurse says. Even if she's the "insurance person" at your docs office, she can't have memorized the requirements for every insurance carrier.

what kind of insurance do you have?

Yeah 200 pounds over goal weight seems like a lot. Maybe they meant you must weigh over 200 pounds or more.

I have heard the same as the others... 40+ BMI and or 100 lbs over healthy weight (BMI of 25)

lane i have umwa insurance where my father was a coal miner..and you each and everyone i am going to contact the insurance company and find out what i can but i have decided i am not giving up on this i want this more then anything

I hope that you do find that you qualify. But if you don't... weighting down? Please don't take that advice. It's fraud. If you happen to gain weight, that's one thing, but please don't consider doing anything dishonest. I know it's frustrating, but people who do such things are part of the reason the insurance companies make so many hoops for us to jump through. What next? Will they require that one of their reps personally frisk people before accepting their weight as fact? How long will it take for others to get approval if they have to wait in line for that? Can you blame the insurance companies for trying to protect themselves? I agree the insurance companies should logical about preventing further health concerns, but the policy is what it is, that's what we pay for. Not what we think it should be.

I'm not trying to be judgemental to any who have resorted to that, believe me I understand the frustration. I was denied 4 years ago and never really knew why. I didn't know about boards like this where I could have come to perhaps learned about the appeal process. I just let it go. But I do fear that people resorting to fraud will only make it more difficult for those who follow.

I was approved and banded on Tuesday, with a different insurance company.

Call your ins company and ask. Mine required a five year history of obesity with documentation through Dr's office notes, showing weigh ins. I did not have that and ended up self paying. Even tho' I had been over 40 BMI for over 5 years, I just didn't have the proof they wanted.

My ins. also required a BMI of 40 or more with no co-morbidities and 35 and over with co morbids, such as diabetes etc.

The five year history is difficult for many people ( that's y the ins. co. asks for it) because if you go below the 40BMI once during the five years, you start over again from where you were above 40. Plus many overweight people avoid or refuse to be weighed at the Dr's visits and then they have no records. I'm sure my ins co. knows that, too and that's y it's so hard to get approved by some of them.

But you need to at least know their requirements! Don't take the nurses word for it!