Hi everyone, I'm new to this sight. I have my first consultation appointment 1/30 for lap-band surgery. I'm going to try and get tri-care to pay for it since they just started covering it last week!! I am very nervous and very afraid that I won't qualify. I do have one quick question for anyone that can answer: Is it typical for the doctor to make your consultation appointment if you don't meet the criteria? I just don't want to get my hopes up. Thanks and HELLO to everyone!

Hi Steve,

It is unlikely you would have a consultation appointment if the doc didn't think you qualified. I can give you the criteria for my insurance, and I think for the most part it is the same in general with others. You need a BMI of 40 or more and be at least 100 lbs overweight. If your BMI is between 30 and 39 (as is mine--about 37) you must have one or more co-morbidities (ailments adversely affected by excess weight) such as: diabetes, high blood pressure, high cholesterol, sleep apnea, acid reflux, arthritis in weight bearing joints, and there may be another one or two I can't remember. I have all of the above except diabetes (sweets are not my problem--too much quantity is). If you want to know for sure, I would call your insurance company and see if you can get them to send you the criteria. If your insurance is through work, you should check with your benefits person who can possibly copy the section of the manual spelling out the criteria. That is what I had to do. I was trying not to tell them what I wanted other than a copy but they said the manual was too large so I told them weight loss surgery and they send me the pages covering the info. Hope this helps. I have had my consultation, psych eval, and just finished up a 6 month diet attempt required by my insurance. Hopefully yours won't require that, but many do want a documented weight loss attempt. My personal feeling is the diet if too succesful makes the insurance company think you can do it on your own and don't therefore need surgery, because the nutritionist I went to who is part of the bariatric team told me she didn't care if I lost any, just not to gain any more. They want to do the procedure so they don't want you to do too well during the 6 months. Catch 22!

Good luck on your journey

There is a possibility that you meet your doctor's qualifications for surgery but not the insurance companies. That was my situation so I was self-pay.

Good luck!

Thank you so much for your replies. It helped a lot. I'll keep you posted as to my progress!

My Insurance Company Required A Bmi Of 40 But Would Wave That If You Have Hypertension, Sleep Apnea, Diabetes, Etc. I'm In The Beginning Stages Also. Had My First Appt. 10 Days Ago And Am No In The Process Of Getting Medical Tests, Losing Weight Etc. Good Luck.

Good luck with everything! It can be an overwhelming process, but is soo worth it. The doctors are usually so good with trying to help get the insurance to approve you!