Out of my element - need some guidance

65toGo · February 23, 2008

Hi all,

First off, I have never posted anywhere before so this is completely new to me. A friend suggested I come to this site to learn more about the lap-band procedure (she's in the process of getting a date for her surgery). Please bear with me :smile2:).

I live in the Sacramento, CA area and have decided to look into lap-band surgery. I had looked into it several years ago but was told by my doctor at Kaiser that I wasn't fat enough (I had a BMI of 42 at the time). I was under the impression that a BMI of 40 or above was pretty much a guarantee that a person would qualify. Apparently not. I've recently switched from Kaiser to Blue Cross HMO and so I'm thinking of trying again. I've made an appointment with my PCP so hopefully I will get somewhere this time.

I don't even know if I'm a candidate for the surgery. I have lost 51 lbs. on my own over the past three years (my BMI is now 35) by being very disciplined (i.e. exercise 6 days/week, eating 1200-1500 calories). It's grueling and every single pound has been a struggle. I've found that if I stop exercising or slip up on my food choices, I regain the weight. The reason I am once again considering WLS is that it has taken three years to lose 51 lbs. and I'm starving and exhausted! According to the BMI charts, I have 65 lbs. to go. I don't want to wait another three years or more to reach my goals.

Anyway, I'd like to know if I am excluded from the surgery because I have less than 100 lbs. to lose and I don't really have any co-morbidity issues except for achy hips and knees. I've visited the UC Davis website regarding their bariatric surgery program and was disappointed to learn they only perform the regular gastric bypass and not the lap-band procedure. Does anyone know if this is the case?

Sorry for my randomness. Any information would be really welcome. Thanks so much.

snowbird · February 23, 2008

Every insurance company is different, so you will have to see if yours will approve you. The support of your PCP is vital to getting your insurance to approve you if you are borderline.

I lost 65 lb on Atkins in 2003-2004, but I had gained back 35 lb by this past summer when I decided I needed the band. My BMI was just 35 but my PCP wrote up every small health problem I had and argued they were all related to obesity, and my insurance reimbursed me for the surgery I had done in Mexico.

Elisabethsew · February 23, 2008

Welcome! As a GENERAL rule, you need to have a BMI of 40 with no co-morbidities or 35 with one or more co-mobidities. The BEST answer is to call your insurance carrier and ask for a written list of their requirements to pay for the surgery.

socaldixiegal · February 23, 2008

Welcome! I had a BMI of 38 when I went in for surgery - and I was self pay as I had no medical issues. At 40 it should normally be covered IF you have the benefit in your insurance (definitely call your carrier).

Self pay is always an option (yes, it's expensive). Realize however that it still could take quite a bit of time to lose the weight. Even after all the research I still had this little voice in the back of my head telling me that after surgery it would all be so easy. It's still a lot of work. Yes - easier than dieting w/out the band, but you still have to make smart choices and still "diet."

I'm glad I made the choice however, I just have to acclimate myself to realizing that it still will take time, work, dieting and exercise to reach my goal. It's a great tool and is making it all easier to deal with so good luck on your path!

TerMur · February 23, 2008

The whole process starts with the weight you are when you go to the first visit with the WLS team. MY BMI was 36. They required me to lose 10 pounds before the surgery, now my BMI is 33. I am due to have the surgery Tuesday. They do not take into consideration all you have lost. They will require you to lose at least 10 pounds from the weight you went to the first visit weighing. You do not want to lose anymore until you get your first weigh in.

Big As Life · February 23, 2008

I Think Some Insurance Companies Will Not Pay No Matter What Your Bmi Is....mine Wouldn't Pay A Dime...i Had Already Had Open Heart Surgery And My Bmi Was 43...they Didn't Care...i Ended Up Doing Self-pay...i Can Tell You This, I Would Do It Again ...i Have Lost 72 Lbs Since April Of 07....

yellowroseaz · February 24, 2008

A good thread to read is For Those with a BMI of 35 to 40. I believe it is under preop and post op questions. Much good luck to you in your journey.

FinallyFree · February 25, 2008

Please call your insurance company and find out what is covered. They will tell you what the guidelines are for qualifying. Make sure you get the name of the person you talk to.

Good luck!!

65toGo · February 25, 2008

Thanks to all for the information! and thank you Yellowroseaz for the tip on the 35-40 BMI link. I found some of what I am looking for. Best of luck to you all.