Just Starting

AprilnTex · February 28, 2008

I've made the decision that I want to be banded. I was concerned because I read where someone's insurance company denied her because her BMI was over 50. My BMI is well over 50. I'm 5'1" and 300lbs. According to the BMI calculator i'm at 57BMI. I wish self pay was an option but my credit is not good and I can't afford to go that route. Does anyone have any advice? I'm glad I found this website. I was starting to feel like I was on my own in this decision. After my sister's harsh reaction when I mentioned to her that I was considering this I decided to only tell my mom and a co-worker that I was seriously conisidering this. Unfortunately my family is 2,000 miles away. So I felt like I was lacking serious support. My co-worker has agreed to be my ride to and from the surgery. She still asked questions like have you tried hiring a trainer or she said Valerie Bertanelli lost a lot on Jenny Craig, have you tried that? It amazes me how even the closest people can be so judgemental. I've sruggled with my weight my whole life and I fell trapped by it but of course I can't expect them to understand. I'm young and I want to feel you. I also don't want to die. Well thanks for listening. Any advice you have to share would be great.

WannaBeMeAgain · February 28, 2008

Oh hon, I know what you mean exactly. My whole family is obese - morbidly obese. I was always the small one - well not anymore. When I mentioned this to my Mom and sister they literally got quiet and then said, "that is the easy way out!" Um, I read the requirements, the diet, etc., it is NOT easy. I can't sit around not being able to play with my kids, bend my knees, go for walks - I don't have time nor money to waste on Jenny Craig - I need results.

Don't make people make you feel sad! Also, when it comes to the insurance company, start researching now. Go to your doctor, ask him or her to refer you to a specialist. Get it all set and then let the doctor deal with your insurance. If it comes down to it, ask them "would you rather I DIE than pay for this for me?" Insurance companies have leeway to contract and change rules - but you have to push!

Good luck to you

AprilnTex · February 28, 2008

Thank you sooooo much for the encouragement. The other thing i'm worried about is being able to provide history that i've attempted to lose weight. I've tried to lose weight probably every year since I was 16 but I never thought I would have to document my attempts. I've pretty healthy besides being morbidly obese so I don't have any doctors records that would relate to my weight.

srknepler · February 29, 2008

Hi April...I'm also in the early stages of learning about LapBand, and I live near Dallas!

I know that my insurance won't cover the surgery, it has an exclusion policy for all things weight related (how stupid, huh?), so I'll have to be a self-pay.

My credit isn't great either, as everything is in my DH's name :rolleyes2: I think that we might look into a Home Equity loan?

Anyway...now I'm just rambling.

I'm going to the LapBand Solutions seminar on Saturday. It's at 10am at the "W" hotel near Victory Park. IT's free...you should go!!

PIP1973 · February 29, 2008

Hi, making the decision to ultimately have the surgery is the hardest hurdle that I faced. I think that the people that are closest to you can be judgmental however they are hopefully just looking out for your well-being. I have looked into Jenny Craig and I think by the time you join, buy the food week after week after week you could have paid for more than half of the surgery.

I am not an American Citizen so I do not know much about the way your Health Care Insurance works .. but I wish you all the best. If you really want this you way find a way to make it happen. (fingers crossed and my thoughts are with you!)

Maya314 · February 29, 2008

I've made the decision that I want to be banded. I was concerned because I read where someone's insurance company denied her because her BMI was over 50. My BMI is well over 50. I'm 5'1" and 300lbs. According to the BMI calculator i'm at 57BMI. I wish self pay was an option but my credit is not good and I can't afford to go that route. Does anyone have any advice? I'm glad I found this website. I was starting to feel like I was on my own in this decision. After my sister's harsh reaction when I mentioned to her that I was considering this I decided to only tell my mom and a co-worker that I was seriously conisidering this. Unfortunately my family is 2,000 miles away. So I felt like I was lacking serious support. My co-worker has agreed to be my ride to and from the surgery. She still asked questions like have you tried hiring a trainer or she said Valerie Bertanelli lost a lot on Jenny Craig, have you tried that? It amazes me how even the closest people can be so judgemental. I've sruggled with my weight my whole life and I fell trapped by it but of course I can't expect them to understand. I'm young and I want to feel you. I also don't want to die. Well thanks for listening. Any advice you have to share would be great.

Hello April! I just wanted to encourage you... really I believe that the decision would be left up to you and your Surgeon. Your family Dr should write your letter of medical necessity in a way that states that you would benefit from bariatric surgery not really mentioning what kind.. this way it leaves you open to other procedures.. just an inside hint.. (I've worked in the medical field for years) Good Luck!

bluekygirl · February 29, 2008

April, don't get discouraged just yet. Not all insurance companies are the same. Perhaps having a BMI over 50 isn't a problem for your insurance company. And if it is, perhaps you can find out what BMI they will cover and see how hard it is to lose that amount in order to have surgery. Of course all our attempts to lose weight have resulted in gaining it all back, which is why we're all here on this site in the first place, but it only has to be short-lived enough for your doctor to record your initial weight in most cases. Just a thought. But I know how you feel - My insurance has a direct exclusion and will not cover any type of weight loss surgery. So, I decided to self-pay. Although my husband is having a major cow over the cost, I consider it an investment. He'll reap the benefits too!

Lots of luck, and don't give up!

MamaHerm · March 3, 2008

Dear ApriInTex,

When I first saw my surgeon, I was 5'0" tall and weighed 308 (BMI 58). He told me that I had to lose 40 pounds before surgery, so I joined Weight Watchers and have lost 26 pounds so far. The insurance girl in his office told me that my insurance company requires a three month diet and exercise program before it will approve surgery. Since I see my surgeon each month, he is documenting that I am following a three month program. What I'm saying is that when you find your surgeon, his staff will know what you need to do in order to satisfy your insurance company's requirements. If they don't seem to know, then find another surgeon.

And about Jenny Craig, Weight Watchers, etc.... I asked my surgeon, "If I can lose 40 pounds by following Weight Watchers, why should I have lap band surgery?" He answered, "The statistics show that only 5% of the people who diet and exercise keep the weight off. 80% of the people who have lap band surgery keep the weight off." This makes sense to me because I know how many times I have dieted and lost weight and then gained it all back plus some. He says that with the band, you don't feel the gnawing hunger the way you do without it.

People can be so narrow minded. At my last Weight Watchers meeting, a group started saying how it was horrible that people resort to such drastic measures like surgery to lose weight, that all they needed to do was to follow Weight Watchers. (Like having surgery was being weak and taking the easy way out!) Even a friend of mine who lost 100+ pounds following Weight Watchers, but gained 30 of it back, told me that lap band was a crutch, and she wouldn't do it. I personally am not going to let these people get me down. I feel that both Weight Watchers and lap band surgery are tools that I will use to help me lose weight and become a healthier me.

So welcome, ApriInTex! I am from El Campo, Texas, (near Houston), and hope to keep in touch with you.

shortgal · March 3, 2008

Call your ins. company and ask what your policy covers. What BCBS covers for one person can be different for another person. This is becasue the ins company offers different policies and your employer might have bought a different policy than someone else's employer. One policy might exclude weight loss surgery and one might cover it with certain guidelines.

As the other poster said, maybe some of us need weight watchers AND the band..... maybe some don't. If the band can help you stay on a healthy eating plan like weight watchers, then why let anyone tell you that's a bad thing.

It's not that our families don't care about us, sometimes they just don;t know what we need. If you decide to have surgery, let your family know that you've made the decision and they can't change your mind and if they really want to help then they should just be supportive. If they can't be supportive then they should say nothing!

Please try not to worry about what your family thinks, you're an adult and by now you know whether the band is something you need for you to be successful.