My first post here, i've been looking for awhile now. I went yesterday for an eval. and a skinny little nurse practitioner w/ no sense of humor told me i was "way off' and to come back when i had gained 60 lbs. I did not get to see the Dr. ( i did see the psych. they have it all in one office, and he said i was a good candidate). i am 5'6" and currently have a bmi of 33.9, i have lots of other physical problems but none alone life threatening. stress incont., big time., extreme shortness of breath w/min. exertion, swelling of the ankles by afternoon, (i am a nurse and work long days) depression, cysts on my ovaries (not PCOS though), joint pain, back pain. . . . .ok ok the NP did not even let me go into any of that. she said bmi of 40 is bottom line or 35 w/ serious co morbids.

Anyone here know of insurance covering the 30- 35 bmi range w/ those type of phys. probs? My insurance co. tells me i need a letter of med. necessity, no other "rules".

maybe i should just gain the 60 lbs like that "well intentioned" NP suggested.

Lisa

5'6" currently 210isa

There are doctors who will work with a lower BMI Lisa...don't be discouraged.

I forgot to mention of course that i have been dieting since i was 18 and i am now 42. i have lost 40 - 60 lbs 6-7 times in my life w/ of course the 10 extra gain each time.

lisa

Lisa,

I am perty sure that insurance will not pay unless you have 100% BMI of 40 regardless of health issues. They advertise a BMI of 35 with multiple co-morbs but I have never known anyone who got it approved. Lap-band WLS approval is always an issue because most insurance companies currently only aprove RNY (bi-pass) WLS.

However, with all that said, let me assure you that there are doctors from all over who will accept a patient with a BMI of 35 IF THEY ARE SELF-PAYING. The question is cost and location. While I am not talking the cost of a new dress, I have to ask you what is the value of a new car compared to a healthier life? It is my understanding that cost for quality Lap-band surgery runs from as low as $11K-$22K here in the U.S. and around $10K if done in Mexico by several truly world-class Mex. doctors. Many here on this forum have gone to Mex. and done sincerely well. But what city and state are you from or what other states might you consider having the surgery? Maybe we can give you some better information that you should consider. Regardless, I do hope you are able to find the help you are looking for.

Always,

Judy

WOW. How discouraging. I have seen the 35 listed in so many places. I am a nurse and work at a hosp. where the procedure is done. I am hoping that by knowing these docs it may help my case a little. i guess we shall see. yuck yuck yuck. Self pay is of course out of the question, i am already in debt up to my ears

thanks for your input.

i wil keep you posted as it goes forward.

lisa

Yes I looked here in the US. My BMI is 32, not only will insurance not cover it, but doctors dont want to do it even if u do self pay. Even the doctor I picked in TJ had to seriously think about it before he gave me the go ahead. I mean, I think it is silly. I told my doctor, "im short, If u wont do it now, I will go eat milkshakes for the next month gain 10 pounds and then I will meet ur requirements." And he agreed that that would not be the best way to do it. My BMI has been high enough at one point or another. I think he likes it at 34 or above. But good luck to you, and I really hope ur insurance will help u. Mexico was basically MY only option.

Weight-loss surgery is considered a last resort for people whose excess weight has reached a point that it is putting their health at risk. The medical community has established some guidelines for how to determine what that point is, and that's the yardstick used by just about every American doctor. Below that point, the health benefits of weight loss do not overcome the medical risks of surgery. On top of that, insurers have come up with their own qualifying standards for patients, involving medical histories and past diet attempts.

People with BMIs under 35 don't even meet the American medical standards for being considered severely overweight, and even with attending health problems wouldn't be medically qualified for weight-loss surgery. So while you may be able to find a doctor who will be willing to do it for a price, you will almost definitely not be able to find an insurer who will pay for it.

Alex is right. Look at it this way too. Even though the lapband is a great option to lose weight.....don't think you can't gain weight after having the lapband. I gained 30 pounds after losing 50. So, If you need to lose less than 50 pounds I don't know if I would do it.

I know some people will be upset that I posted that, but, I have to be honest. I thought I wouldn't be able to gain it back, or at least not more than 5 pounds because of the restriction.......I found the opposite to be true. The more the restriction the less weight I lost/or the more weight I gained. (it's hard to eat anything good for you at that stage without being frustrated and reaching for the foods that will go down.......milkshake, chocolate etc.

I know it seems frustrating when you want something so bad. Now I am down to hardly any restriction had plateaued for about 6 months. Started NutriSystem and have now lost 24 more pounds.

Although I understand everyones feelings, I think everyone comes here for support. My BMI has been up to US standers before, and Im sure without banding, it will agian. My thyriod is ruined all ready at my young age and so is my selfesteem. Im sure this is the case with most other lower BMI patients and the same understanding and support that we "lower BMI's" offer those here should be offerd to us. But then again that is just my oppinion. I understand what people are saying about health risks, but im quite sure we have thought of this ourselves and if we are willing to risk it, then it is as important to us as it was to anyone else here. And also I am quite sure we have done everything we could think of and all those silly diets and nothing has worked for us as well. This IS also our last attempt.

Warning: Some tough love coming :

I was a BMI of 33.7 and insurance carriers probably wouldn't have even come close to touching me and I didn't even TRY. I self paid. Why spin my wheels anyway? Trying to get insurance to pay for it didn't even really cross my mind. If it is something you want, just get a personal loan or take equity on your house and get it. Don't get frustrated with the insurance issues. The cost of the surgery is the same as a used car, but you get this car for the rest of your life! Plus, the more people use insurance through "creative recomendations" the more we (the public) pay for it in the long run in higher premiums and copays. Gaining 60 lbs on purpose is absurd! What if you cause more damage to your body that you think? What if you damage a knee and also need knee replacement after gaining all that weight? What if you slip a disc in your back from gaining all that weight? The what if's are too complicated to fathom someone purposely gaining weight just to get WLS insurance paid.

I have known people that have sold their newer cars and are driving a 89 escort to pay for this. Or having big garage sales, creative savings accounts, selling on ebay. Whatever, to help pay for it. I know I had $200 each paycheck direct deposited into a special account just to help pay for this. It is definitely tight, but will only be tight for a year or two untill it is paid.

I am/was a low BMI of 33.7 and I must admit that I think of it more as a cosmetic treatment (in my case) rather than a life saving surgery. Me losing 75 lbs is not going to save my life. I compare it more to getting a boob job or my nose done. I wouldn't try to get insurance to pay for that either. I will be totally honest in that (for me) I did this more for self esteem and the actual weight loss tool rather than to save myself from any comorbidities. Sure I could have done it myself with exercise and dieting but would bounce back and not be able to keep it off. Been there, done that several times.

I applaud you for recognizing your overweight problem at a 33.9 rather than waiting until you are a 45 or above and suddenly realizing... shit, i need help. I think that in itself is commendable. Now I am definitely not saying that severe morbid obesity people should not get to use insurance. Everyone has different histories and pasts and stories. I am just saying that I am against any creative writing to get insurance carriers to pay for a surgery that is more cosmetic than it is life saving or altering. You may "feel" it is life saving or eventually would be, but it isn't. Aching bones, joints, swelling ankles, depression, shortness of breath with exertion are all things that you will not die from and will stop once you lose the little amount of weight. I have known those that probably would have died within a year had they not had the surgery because of serious comorbidities. I think insurance should be reserved for them.

While I am ranting I also feel that any cosmetic surgery should be covered individually and not by insurance. Hanging skin or boobies, again, is not life threatening and is not going to kill you. If someone wants to feel better about themselves physically, they should be paying for it. Just my opinion of course.

I may be taking a hard stance on this but as a lower BMI bandster I think I have the right to speak out for the other side of the view. Rather than thinking that it is unfair for them not to cover me, I understood why they didn't.

Of course as a reminder/disclaimer: I may have posted strong opinions but in no way am I attacking anyone personally, just posting MY opinion only. Opinions are like assholes, everyone has one. Take what I say with a grain of salt and just let it sit in the back of your mind as just one persons opinion.

Jenna, I believe the saying goes.."opinions are like asshoes, everyone has one and they all stink." I love that one!!! Very well put....bravo

Hey Jenna, not all plastic surgery is cosmetic. My skin grafts are defineatly not cosmetic, allthough the wafle pattern on the larger on is ... decorative After my DH finally loses all his weight, his paniectomy won't be cosmetic.

I think it is currently on a case-by-case basis.

One thing we also need to keep in mind that the BMI is a scale, and we know scales lie! I know that the last time I had a BMI in the low 30's I wasn't fat. I look at the pictures now and wonder why I thought I was fat! (well, talk to my mother...)

BMI BMI BMI WHAT A LOAD OF CRAP..I have two friends they are both of the same height and same weight .One looks terrible thin and the other looks cuddly.Answer that one.You see I believe some people have small frame so they can carry more weight although the scale say skinny they are in fact chubby and the larger frame women can be the same weight yet have no fat one them,however if the larger frame women then ends up with the same amount of fat all over as the smaller frame women..OH MY LORD SHE IS A VERY BIG GIRL.You know if you are on the heavy side you don't have to defend your self that you are big enough to us fatties .I know when I went to see my Dr I secretely hoped he would say Iwasn't as fat as I thought I was ..BUT NO HE DIDN'T.Good luck with your journey.

Hi!

I am also a lower BMI patient. I had a BMI of 33 on my day of surgery (March 2, 2005) I chose to go the Mexico and use Dr. Oritz (Obesity Control Center). I just know there were very few drs. in the US that would perform the surgery on this BMI. The cost was approx. $9500 (plus transportation). I definetely would not spin your wheels with the insurance issue, you'll just end up frustrated. So far I think it is the best money Ive ever spent. It's been 6 1/2 weeks and I am down 17 pounds and feel great. I've had tons of energy for exercize and getting used to the bandster way of eating hasn't been bad at all. I loved Dr. Ortiz and all of the people he had working for him. The experience for me was comfortable and as easy as possible (although it is surgery after all!!!). One thing to point out though when you are making the decision, the band DOES TAKE WORK!! I think in the beginning I was alittle unrealistic in my goals and how the whole thing was going to work. You still have to use lots of self discipline and it isn't a quick fix. I also think (my opinion) that with lower BMI patients its even more so! We lose slower than higher BMI patients usually, and it may take longer to find that really good restriction with fills?? With all of this said, I am soo glad I did it and would recommend Dr. Ortiz if you are going to go the MX route.

Best of Luck, Monica

Also, I have no personal experience, but I think I remember someone saying that Dr. Spiegel in Houston does some lower BMI patients and I think the cost is $15K? You may want to check it out??

Well I did not expect to get so many responses. i am feeling a little confused here. Let me start w/ i can no way afford self pay. My wt has fluctuated 40 - 70 lbs over the last 20 years, currently at 212. What about the info out there saying some will do the surgery for a bmi of 35- 40 w/ other physical probs. I can lose wt, check it out. . . . a low of 139. . . a high of 245. So I feel like the band could be an excellent tool for me. I eat big meals, to the pt of overstuffing often. . .about daily. . . NOW i guess if i wait about 6 months or so i could be right back at the 240. . . after all i gained 60 in the past 6 months after a nice 45 lb loss on atkins. So yes i can diet and lose, do i want to continue to yo yo diet for the rest of my life . . . i think not. It sounds like some of the people here think i am looking for an easy way out.. no. i want very much to be able to maintain my weight loss for the rest of my life. 75 lobs to lose is not exactly like i am a stick and bones here. i wear a size 22w.

is there anyone who knows of coverage for bmi 35-40??that is my question. I don't really want to be made to feel bad , like i am trying to finaggle the ins. co. or commit ins. fraud here. i am just looking for info on the 35- 40 bmi crowd. the lap band sites all over talk about the 35 - 40 bmi chances but all here seem to think only >40 have a right to get it paid for by insurance.

lisa

I know my husband's BMI was lower than the insurance would take....he gained weight to qualify...I too would not recommend that. For the same reasons listed above plus...what if he wouldn't have qualified after he gained then he would have no surgery and be 20 pounds heavier.

What helped him was his family history diabetes, heart attacks, poor circulation etc

His doctor had to write a letter why he needed the surgery.

BMI's suck. I think mine was 42 I can't remember I was 282 and a 24w. So see, if you are 22w our BMIs were completely different, but, we were wearing almost the same size. But, I guess it is fairer then just going by weight because "The Arnold" in his heyday would probably be considered overweight because his muscles weigh more than if he didn't have them. But, he would have less fat.

As I said earlier unfortunately you can gain your weight back even with the lapband...you have to weight the risks of surgery for yourself. When I look down at my scars each day with after almost 2 years are still there I get depressed and tell myself I can't believe I needed to have this surgery to lose weight. Then I tell myself....Denise you were 282, had sleep apnea, high cholestrol etc. You had to do something.

I can't answer how you would feel after having surgery. I have 120 pounds to lose.

Self pay may be the only option for you but think about it this way too. They won't insure me because they don't think I am the right kind of candidate......Am I really a good candidate? The lapband will not change any psychological problems you have about your weight or your life unfortunately. Something I have to deal with on a daily basis...and make good choices to do the right thing to help my weightloss. Because when I get depressed or worried, or anxious, or sad, or lonely.....I know a bowl of ice cream is what I'll reach for and it will go down just fine. The lapband didn't all of a sudden want to make me instead eat a bowl of carrots.

I have to disagree with the poster who thought it was cosmetic. I don't think of this as cosmetic. I have a device in my body that possibly could cause problems, or need replacing in the future. But everyone has their own opinions on their lapband.