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

Isn't it funny, Lisa here weighs 212, BMI of what, 32? and she's a size 22w.

before my banding, I weighed 271, BMI of 47, and wore a size 24/22w.

Again, proof that the scales lie.

Thank you for sharing your stats Lisa . This has given me something to ponder.

Lisa, any doctor who does bariatric surgery will consider people with a BMI over 35. The usual standard for medical necessity is that with a BMI of between 35 and 40, a presence of "co-morbidities" is required. Those can be any condition that is caused by or exacerbated by excess weight, and which will be improved by weight loss. Diabetes, high blood pressure, sleep apnea, and joint pain are some of the more common ones.

So basically, the standard is if your BMI is over 40 you are considered ill and qualified for surgery even if you're otherwise perfectly healthy. If your BMI is between 35 and 40, evidence of specific health problems is needed to establish the medical necessity for bariatric surgery (of which banding is only one kind).

Doctors and insurers both use the same standard for qualification, so if one agrees on the medical necessity the other should too. Then, of course, you have to deal with whatever other issues your insurance company may raise. But the bottom-line standard of medical necessity is not a gray area--all American doctors and insurers are pretty much on the same page there.

The medical community finally sees morbid obesity as a disease and recommends that it be treated as such, which is the reason weight-loss surgery is being covered by insurers at all. It may not seem "sensible" if you're the one wanting it and being denied, but it's widespread medical practice to use standard measurements to assess the severity of disease. And it's the ethical and sensible way to determine if insurance should cover it.

All of this is said with the caveat that there can and will be exceptions, of course. But as a starting place, the BMI scale has broad medical support and seems logical to me.

Do you think that your statitistics on your BMI could have been wrong? Maybe you might need to have it retested by another doctor. It does seem a little odd that your BMI would be that low when you wear a size 22w

Yes I looked here in the US. My BMI is 32.

32???? I can't believe you are considering the band. It is actual surgery and I think these docs are right to reject someone so light. When my BMI was 32, I only wanted to lose about 30 more pounds. Surgery is NOT the answer for someone with such a small BMI.

By the way, I had a BMI of 47 and was self-pay in Mexico.

I couldn't find is she posted how tall she is, but at 5'5', her BMI comes out 35, so I am guessing that she is taller, maybe 5' 8". Again, it is a scale and scales lie. To get a true idea her fat ratio, she should either be tested with an electornic scale that uses electrical impedence, a skin fold test (the "pinch" test) or be weighed underwater.

Part of the reason my BMI is so high because I've been on steroids for huge wacks of my life, starting as a small child. That, and my family is just naturally more dense than normal. At a size 22 with a BMI of 32-ish, I would strongly recommend these tests. (sorry, you might be fatter than you think...)

My BMI was 33 when I had surgery in March. I had lost 8 pounds prior to surgery following the pro-op diet. Since banding I have lost 20 pounds. So there are people out there with BMI 's less than 40 that are getting weight loss surgery. I especially disagree with anyone that is being critical of someone looking at their options or trying to get information. A person with a BMI of 33 to 35 is by definition obese and if nothing is done to correct that obesity then it is just a matter of time until they are severely obese and after a BMI of 40 they will be morbidly obese. Unfortunately, most insurance companies will only pay for the surgery if the patient is classified as severely obese(BMI>35 with comorbidities). However, if your insurance company only requires a letter of medical necessity why not have your PCP write one stating all of your problems related to weight. Most people don't know this but if you overweight you more that likely suffer from Metabolic syndrome. This is like pre-diabetes and every type II diabetic out there had metabolic syndrome prior being a diabetic. If you have Metabolic syndrome long enough guess what you become a full blown diabetic. Do you suffer from reflux, joint pain or stress incontince? I did and these symptoms are already getting better. My point is please don't let others that don't know your situation discourage you. Have some blood work up done- ask to be checked for metabolic syndrome most endocrinologist will gladly test you for this! Find out what is required for approval and submit them. You will never get approved without trying! So what if you get turned down then you can appeal also! Best of luck to you!

i am 5'6", current weight 210 i think this puts my bmi in the 33.5-34 range. i would like to weigh 140, that is 70 lbs, of course i could be pleased w/ 60 lb loss, any way i have plenty of co-morbids. i will just wait til i am about 5- 10 lbs heavier, god knows that can't be far off. i have stress incont. , jt pain, poss sleep apnea, back pain, depression. would that do it w/ bmi of 35?

lisa

FAUXNAIF:

Anyone who would come here and attack me that way can go to hell. It is my choice and I think everyone here has had people hurt them because of their wieght. So i guess im not skinny enough for the rest of the world and not heavy enough for u. What a rock and a hard spot hu? Where can I go if I cant come here for support? We are all overweight and have the same pain. Hope it made u feel better to judge me when u have never seen me or met me. I am about to have surgery and I come here for support, if that is all u have to say then keep it to urself Fauxnaif. I would never be so critical of someone. My choice, my body, and this is a support group. Not a you know it all group. By the way, i dont think u post here often do u? Funny how new users pop up when someone wants to say something so critical.

Bandit, I don't think Fauxnaif meant anything hurtful by those comments. Please don't be insulted. I can understand someone expressing surprise when people with such low BMIs even consider weight-loss surgery. Obviously we don't know everyone's history, but I know when I started out I couldn't imagine ever having a BMI as low as 32 (which I am almost at now). Since I've taken 18 months and a loss of over 100 lbs to reach this point, it's does seem odd that someone else at the same place I am now could be considering weight-loss surgery.

Of course, banding isn't like RNY and could be seen as a relatively minor procedure. That may be the way it's perceived outside of the US, where the strict qualifying standards may not be used. It may have a perfectly wonderful role in weight management for people of all levels of obesity--but in the US we have this bright-line determinant for the time being.

Everyone has to come to their own conclusion with regard to whether banding is the right tool for confronting a weight problem, and we can't make judgments for others. One man's floor is another man's ceiling, in WLS as in so many other things.

bandit,

Some people can be overly sensitive. And, I am sure that some are just jealous and wish they could have a BMI where you are, it is hard for them to relate. I know when I started gaining weight and I was where you are now, I felt similar to how you feel. I wished I would have had a way to stop the weight gain then, instead of waiting until I needed to lose 120. I am proud that you are being proactive in trying to find a solution that will help you. As you will read in many posts.....many wished they had had the surgery years ago.

Just realize the Lapband is not an easy life. Is it what you really want to do at this point?

With best regards,

Denise

yes u r right. Prob a little over defensive today. But I felt like that was a tactless way for them to express their feelings. Could have been put in a different way. I mean really. I have had a hard week with trying to make all the many arangements for my band surgery. And of course the doubts, the fears, the tiredness and readiness to change just like everyone else. That post was NOT what I needed. Thank u for understanding Denise. U put it perfectly. If u read my intro post I wrote when I joined LapBandTalk, it pretty much mirrors what u just wrote about wanting to get a grip on things before I end up like the rest of my family. I want to get a grip on things now while I am young and before I spin out of controll anymore. Thank u for ur post. It really made me feel much better.

Lisa, I have a BMI of 38% and my insurance carrier is covering my surgery. Each insurance carrier has their own rules. My carrier required that I be either BMI of greater than 40% or 100 pounds over my "ideal" weight, or a BMI of 35%-40% and at least 1 "co morbidities". They included high blood pressure, asmtha, sleep apnea, diabetes, chronic joint pain, chronic back pain and they would consider other chronic illnesses on a case by case basis.

In theory you could have a BMI of 35% and the problems you have now and insurance would cover you. But in practice you really have to check with your insurance co. and see a) if you are covered for weight loss surgery, if they cover banding, and c) what their requirements. Each carrier and each policy is unique.

Don't give up hope and good luck!

HEllo Lisa I cant speak for anyone else here but my BMI is 38 and i was told that no way would my ins. [pay for it i have BC BS Tx and they have it is wrighting no weight loss cover so i will have to self pay i guess ill make that final decission tomorrow i am also a nurse , yo yo dieter, lost 30 with atkins put 40 back on went to md yesterday for an infection in my finger and found out i could add another 9# to that arughhhhhhhhhhhhhhhh

Good Luck

Ramona

Ahhhhhh, I guess all I have to say is: "don't hate da playa, hate da game!" okay, so I got a lot more to say actually....

First things first... I don't feel that ALL plastic surgery is cosmetic nor is the band always cosmetic. But I do feel that the band was cosmetic for ME as I am just being a realist on how I feel about it. Doesn't make me (or anyone who feels this way) "less deserving" at all.

I am all for lower BMI's getting the band as a weight loss tool. If someone is a BMI of 29 and they want the band, hell yeah go get it. yes, it is a surgery but so is breast augmentations. So is it your opinion that a certain cup size are not allowed breast implants? Now, I may not feel that lower bmi's of under 35 should be getting bypass but come onnnnn, this is a implantable and fully removable and reversable operation that is minimally invasive and carries little risk. In many cases it is outpatient surgery. Just because it has the words "weight loss surgery" attached to it there is a qualifier for it. I don't call it WLS when I talk about it to others as they automatically assume bypass or stomach stapleing... I call it WLT (weight loss tool) and then I explain.

The only thing I am really "against" is designing ways for insurance to pay for it when it is more cosmetic than life saving. It is definitely a CASE BY CASE basis. And YOU AND YOUR DOCTOR are the only ones who can really determine that, not anyone on this board. If it is life saving, insurance should pay. If it is cosmetic and you just feel icky about being fat (like me) then pay for it yourself and don't eventually make us all pay for it in higher premiums, difficulty in getting other necessities covered, etc etc. And I say this as obviously as the devil's advocate so to speak as I am a low BMI that paid out the nose. Would I have liked insurance to pay for it? well sureeeeee! But at what cost to everyone else and am I really contributing to the healthcare insuance issues in our country if I did? Maybe I overthink things and think one person CAN make a difference. When my healthcare insurance premiums are rising yearly and I never go to the doctor, that ticks me off a bit. And I don't even want to get started on the entire welfare/state paid insurance for low income/homeless, that is a wholeeeee 'nother egg to crack for me.

Now, I have noooooo idea what your situation is. But I can tell you that I had depression (I am fat and hated it), I have joint pain (well duh, I was fat), I had stress (umm, again, I am feeling like a cow), I have back pain (hello cow lady here), I am snoring like a freight train these days, possible apnea (again, my weight gain). None of these things I (note the use of the word I) consider morbidities as I will not be dying from the fact that my knees hurt or I feel like I look like a cow so I get the blues. But... it is fixed by losing my weight.

BOTTOM LINE: It is an individual choice and individual lifestyle option.

As a BMI of 33.7 (and one of those OMG what is she doing candidates, size 18, 5'8" tall) I can tell you to stick... okay, I won't go there tonight I guess. I will be good. But don't hate on someone that chooses to change their appearance because they actually took a good long look at themselves int the mirror and are catching their weight gain early enough to NOT have the physical issues that come with being morbidly obese.

As someone who was once digging in her couch to find a quarter to go buy Top Ramen for my daily meal I can tell you that if there is a will there is a way. I will be honest in that my parents (although I wouldn't accept their money) used to come visit and purposely drop money in my couch or crumple a $5 and stick it in a pocket of my jeans in the laundry. I never to this day told her I knew she did it. Anyoneeee, can afford this. It just takes manipulative planning and saving. It may not be next month but I guarentee that it can be done with the right limitations and restrictions on money spending. (for example: a friend of mine was living with her parents, complaining how broke she was, getting her car repo'd, yet she was paying $200 a month for a storage unit to house all of her garage sale crap (broken walmart dressers that weren't going to feed her or her child) and these cheap figurines. Go figure. It took a few months (and many heated arguements), but she DID get on her feet again and is now doing great.

Now a summary so there is no misunderstandings about my opinions:

1. Low BMI's (or I don't even care if they are 5'2" and 100 lbs) if they want the weight loss TOOL then so be it. Their choice, their body.

2. Because of the insurance and healthcare issues of the US lower BMI's without LIFE THREATENING conditions should not try and take advantage of the healthcare system for coverage. (but again if they need it to save their lives, then do it and have insurance pay for it!) Just my opinion that is all.

3. Mexico and Europe have been banding for 4 x's as long as American doctors so therefore just because they are "american" standards does not make them golden.

4. I appreciate everyone's opinion on things, good and bad. yes, some of it may piss me off a little but I still respect your right to have an opinion nonetheless. All comments here are appreciated and thought about. I do not dismiss anyone's comments.

5. I am in no way bashing anyone for being morbidly obese and not doing something sooner, I am merely saying that just because someone notices an issue sooner they should not be persecuted for it. In my particular case, coming from a family with severe morbid obesity, my personal battle with an eating disorder and at least 3 immediate family members with RNY GBypass, I only noticed my obesity sooner and was more aware due to my elders.

6. Debate is a GOOD thing, not a negative thing. It is healthy and makes us more aware of how others feel, even if we do not agree.

7. Weight-Schmeight! Who cares? If you want it, get it. If you need it, get it. If you can afford it, spend it. If you can't afford it, finance it.

7. Do what ye will, yet harm none.... words I try and live by.

I again commend any lower BMI's who are stepping forward and recognizing their obesity and getting it under control now instead of later. I think it is admirable. I also think that those high BMI's that have come to terms with their obesity are also respected in the fact that they are taking back control of their pysical and mental self and creating a change to be healthy. Because bottom line that is all it is about right? We all (low bmi or high bmi, everyone) want healthy bodies and live life to its fullest.

Thank you to anyone that took the time to read what I had to say. I greatly appreciate it.

hi Lisa,

My insurance company (a NW company--Kaiser) SAYS in their written policy that they cover weight loss surgery 35 - 40 bmi if you have other conditions related to obesity. You have to have a combination of things like one good one is to have a sleep study done and be formally diagnosed with sleep apnea. Having diabetes is a good one. :0) They like to see that. Serious joint break down, documented. Asthma. Heart problems. As it turns out with my insurance company, even if you show and document ALL those things you still have to see their dietician for a year, go to group support, go on their diet and exercise program for a year and if you STILL are at the same weight, then maybe they might do the surgery. As if we don't all already know what does or does not constitute a healthy diet, and as if all we need is one more diet. We all gain it back is the problem. For myself, I was 37.7 BMI. I knew I'd never get approved by Kaiser, and wasn't willing to gain 60 lbs to do so. I also know my genes aren't the greatest. Diabetes runs rampant through my family--if I don't get my weight down and keep it down it will happen to me. Kaiser wants to wait til I does--I don't! There are also heart problems in my immediate family. I don't have those yet--and don't want to. I've also had one bout with breast cancer, thankfully detected very early on. Once you've hit 50 years of age, even 40 lbs of overweight DOUBLES your chance of getting breast cancer. So it's very important that I stay--all my life--less than 40 lbs overweight. My obese aunt is dying of breast cancer as we speak. It's deadly important for me to keep my weight down. And yet . . since I don't CURRENTLY have diabetes, heart disease or breast cancer, they won't cover me for weight loss surgery. I had to take out the loan, whether I could afford it or not, and just do it. Good luck to you. My sister went outside her insurance company to visit a bariatric doctor and paid out of pocket for a few visits to him. He was able to help her with jumping through all the insurance hoops and help her document her obesity-related conditions, more to their satisfaction, so at his recommendation her own insurance company was more willing to talk with her about it. You could try working backwards on the problem that way--just a thought. Good luck to you! I'm sure you'll reach the right decision for you.