I have finally decided that the LapBand is my last option. But my PCP states that I still have to do a 6 month Physician supervised diet before insurance will even consider it. These are going to be the longest 6 months of my life. I only fear that even after I get through the 6 months my insurance is going to deny it since I am only a BMI of 40 and have no co-mobity problems.

I'm really nervous about going to see my PCP. He believes that you should only eat when you are truly hungry. That isn't working. I have to get him to show medical proof that I need a lap band in order for my ins. to cover it. I feel like you. I don't want to wait several more months. I have pretty much made up my mind to do it. And I want it now too. Do you have any suggestions for what to say to my PCP to convince him that I really need the lap band?

Hello Yellowroseaz,

In my case I am 252 with my shoes off and have a BMI of 40. I have already done all the diets and pills. I even went to a psychiatrist to see if I had depression and he put me on a medication that was known to help people lose weight with no luck. For the last 7 months I have been working out with a trainer 3 times a week for an hour and been doing JC since Nov and only lost 1 lb so even though I do not have any medical complications I think my PC P finally realized that it was time. Now if I can just get my insurance, PacifiCare to see that. I think if you can show to your PCP that you have tried everything else he/she might see the light. Have you gone to an informational session? I am going to go to one next month to see if there is anything else I need to do to prepare. I also suggest reading the post listed here. I have been doing that for a couple of days and getting some great information. Good luck and keep in touch I would love to hear how things go for you.

Welcome! Try explaining to your PCP that you have educated yourself in weight loss surgical procedures and that the lapband is merely a tool to assist with your PCP advocates. You might even try journaling for a few weeks and present that to him/her. If all else fails, consider a new PCP.

My suggestion would be to start saving money. VERY few insurance companies will approve a BMI of 40 and no co-morbidities.

It's starting to become more and more affordable nowadays, but I would also say that as in most things, you get what you pay for.

Good luck!

If it's an insurance requirement that you have a six month MD supervised diet program, there is no way around it. I had TWELVE months, it is doable, it gives you time to get things arranged, get your mind wrapped around the changes that have to happen (and even though you think you know, you really don't) and sometimes with the pre-op testing the docs want, that can take a couple of months to get scheduled. So use this time to see your PCP MONTHLY (don't miss a SINGLE visit, or you'll be starting over if that's what your ins co requires), go see a surgeon (call your ins co and see who they'll cover for you to see) and start getting your pre-op requirements out of the way.

GOOD LUCK!

I agree with Faith. I was self-pay and from first appt to surgery was less than a month. I didn't even have time for a good last meal before I was on my pre-op diet to shrink my liver. I didn't get very much time to wrap my head around all the changes although I did research and think about getting the lap band six months prior deciding to go through with it. Still, five days post-op I'm still wondering if I did the right thing (even though I am 24 lbs down as of today). I know in the long run that I will be happy that I did it, but that doesn't cross your mind when you have to go through the McDonald's drive thru on the way home to get your teenager something to eat because you are in a hurry and you have to sit there and smell it when you have only had Clear Liquids for a week. This is a very long and slow process. You definitely want to make sure that your head is in the right place.

I understand your frustration and wanting to get it now. But sometimes it's better to take things slow, especially with such a life changing procedure.

If you have insurance I would call the them and see what requirements that they have. You might be surpised you have everything all ready for them. It might take you about 3-4 months to get everything together if you have gone from doctor to doctor. Once we meet the doctor it took us less than 3 months to get everything submitted, did his testing requirements and sent the paper work in. If you would like please send me your e-mail and I will send you an example letter that we used to get approval. Also another person who could help you with things is your OBGYN as well. The wife and I are very please with the band and enjoying are new life.

Chris

Thanks everyone for the good suggestions. I have started to get all my documentation together so once the six months have passed there will not be any more delays. I am also going to attend an informational presentation by a surgeon in my area next month to see what suggestions they have. I am just really frustrated because I still have not got a return call from the dietitian that I am supposed to see about the six month diet. I have called twice and left messages. If I could at least get this first step started I would at least feel like the process is underway.

Take that first step with the informational meeting. You will get some suggestions and things will fall into place. Like Jax said, you need the time to get your head around the entire process and how this will change your life. Think of the end result. My surgeon was so sure that I would be approved after three months in the program. I had lost 33 lbs during that three months and he said that he was sure it was a go. Well, all my paperwork went in for approval. Got a call last Friday that I was denied. I had a BMI of just 40, minimal co-morbidities. I cried for about 30 seconds after the call. Picked myself up and decided that another three months is not so bad. I actually have enjoyed challenging myself on this diet and feel sooooo good about the fact that I was actually able to do this ALL ON MY OWN. I know that it will all prepare me for what is ahead once I get my band. And you know what? If I am not approved I will go to Plan II and go for the self-pay. I want it that much.

I hope that you can get into the mind set where you get excited about the process and set your mind to know that there will be hurdles throughout this process. Your surgeon and your insurance company will want to see that you are serious about this and that you are willing to work at it. I wish you luck and hope that you can get your necessary appointments set up so that you can start you lap band journey.

I should clarify...I was denied only because my insurance company requires the 6 mo. pre-op preparation period. My surgeon said that insurance companies will accept with a 40 BMI when a person can prove they are serious about committing to that six months prep time.

Don't give up! My insurance approved me with a BMI over 40 and no co-morbidities that I am taking medicine for. I have the beginnings of some though. I had to have a 5 yr weight history, psych evaluation, and support letters from my PCP. In my 5 yr weight history my BMI was a little below 40 two of the 5 yrs. It is doable.

CALL your insurance company and find out everything you can for your documentations. How much details do they want from you dr. about the 6 month diet. Make sure they require the diet and it is not just your PCP.

I too will have the 6 month MD supervised diet. I was a bit tweaked about it for awhile, but it's going to allow me time to prepare myself for surgery and it will give me time to do more research into what I need to do AFTER the surgery to make sure I use the tool effectively.

Plus, if nothing else... I figure the 6 months will help me save up some sick time so that I'll be able to take off as much time as I need to heal after getting the band.

There's an upside to everything. :biggrin:

That is stinkin thinkin. I too had to wait the 6 months and had no comorbidities. Like the Nike commercial, Just Do It! You'll be glad you did. And forget about what you feel your missing. When you get there you'll be glad. Enjoy the ride!

For those that have done the 6 month or more diet did you lose weight? If so doesn't that hurt your chance of getting insurance to pay. I guess the way I look at it my diet is my problem. I can eat well but I am always hungry. I exercise regularly. That is my case to my insurance company. Lucky I have proof of my attending Jenny Craig a couple times and of working out with a trainer so I think that will help make my case.

I am getting my mind around the fact that I have to do the 6 months. I have been to the dietitian at my PCP's office before and I think I will only have to go in once a week. But I still have not received a return call from them

I did do the 6 month weight loss and didn't loose but maybe 5lbs. Does it hurt your chance for surgery? For me it definitely did not. When I was going for the updates monthly, the nurse that was with the Bariatric dr told me how many people don't go through with it. Every month I would show up to the PCP office and weigh in. Then I would call and talk with the Bariatric nurse.

It seems they (the insurance companies) do this as a test for those that want the surgery. If you give up and don't go through with the 6 months worth of visits, then their take is your not serious about everything after the surgery. The updates and the diet, etc. That is the attitude the insurance companies take. They do this because many many people drop out and won't go through with it. From what I understand from the Bariatric Nurse, very few people that have to do the 6 months do it. Like 25%.

Just go and show up. Don't pressure yourself on losing weight. Try, but don't knock yourself out if you don't. Make the appointment and show up! The 6 months will go by quickly.

That was one of my issues before surgery. I was hungry all the time. True hunger pains. I would eat lightly and then be hungry. This will be taken care of when you have the surgery.

But in the mean time, do what you need to, to get the insurance to approve you.

Good Luck!