I am interested in getting the Lap Band done and have not even approached my doctor yet. I do have an appointment next week. I am 26 years old, 5'8'' and 245lbs. I have had issues with acid refulx, high blood pressure and borderline diabetes. My BMI currently is about 38. My biggest fear is to get excited about this tool that will be so beneficial to me then come to find out that I don't even qualify for it.

What is the first step when considering this type of surgery? Does anyone have any tips on insurance coverage (I currently have kaiser so.cal and am thinking about switching to Aetna)? Has anyone had this surgery with Aetna insurance? I am also wondering about hospitals, after surgery diet, recovery time, etc.

Any help would be wonderful!

Gabi

Hi -

I've done alot of research when it comes to Health Ins. Companies. I do believe your BMI qualifies you, but you would need to be diagnosed with either diabetes, high blood pressure, or heart disease. As far as what your Ins. company requires - you would need to call them directly or look online for specific reqirements. :-)

You are already doing the right thing. It all starts with the thought. Then a conversation with your Dr. He/she will the direct you. I was just your same size and BMI and I qualified due to sleep apnea and borderline diabetes. My surgery was June 26th and I have lost 40 pounds! I have never felt better physically or emotionaly. Good Luck!

Im totally confussed as well. Im also a newbie too.. Anyways I have Kaiser So Cal, and Im wondering do they cover Lap Band WLS if not next month during out open enrollment , I will switch to UHC. Help PLEASE!!!!:w00t:

Kaiser So Cal does not cover it yet. I have heard that Kaiser Nor Cal does but for some reason the two don't talk the same language. I will be switching to Aetna during open enrollment. I would go to your potential new insurance website and look up their policy specs. I have noticed that for the most part the general requirements are similar, but not exact. I have my dr. appt with my Kaiser doctor this friday and I'm really nervous! I don't know if I can start the dr. diet now and have it count when I actually switch or not...cross your fingers for me.

I am interested in getting the Lap Band done and have not even approached my doctor yet. I do have an appointment next week. I am 26 years old, 5'8'' and 245lbs. I have had issues with acid refulx, high blood pressure and borderline diabetes. My BMI currently is about 38. My biggest fear is to get excited about this tool that will be so beneficial to me then come to find out that I don't even qualify for it.

What is the first step when considering this type of surgery? Does anyone have any tips on insurance coverage (I currently have kaiser so.cal and am thinking about switching to Aetna)? Has anyone had this surgery with Aetna insurance? I am also wondering about hospitals, after surgery diet, recovery time, etc.

Any help would be wonderful!

Gabi

Gabi we could be twins! I am 26yo, 5'8" and 250lbs, with a BMI of 38. My insurance only covered the surgery with a BMI of 40+ (which automatically excluded me). They would cover a BMI of 35-40, but they required 2 comorbidities along with it, which surprisingly I don't have. So my husband broke down and agreed to pay out of pocket for it. I'm getting banded 11/5/08 in Colorodo with Dr. K. He has his own thread in the Doctors forum, you should check it out. His website is there as well. He only costs $9950, and that includes everything but travel/hotel. :cursing:

First of all I want to say hello fellow Pasadenian, anyways well my dr's appt @ Kaiser Woodland Hills is tomorrow and now since I found out that Kaiser doesnt cover the Banding procedure ( I just called memb serv 45 min ago) I guess Ill just be shootin the breeze until next month when I try to switch to United Health Care. No need to waste time. I guess Ill just make sure my records and history are up to date. I wish I could just stay with Kaiser since Ive had them for dang near my whole life.... Im just so tired of the yes no's and maybe so's with Kaiser providing the Lap Band or not. :~)

jmegirl, Do you live in Colorado or will this be a trip for you to go to this dr.? I am so nervous about my drs appointment tomorrow because I am afraid they are going to say that I don't qualify. I have no "diagnosed" comorbidities, but I have documented high bp and prediabetes. They didn't ever give me meds for them though. Is it sad that I did the calculation and it would only take an additional 20lbs to get me to a 40+ BMI. Who was your insurance through...I hope not Aetna PPO.

Good luck on your surgery, I bet you are soooo excited! Keep me posted on how everything goes.

Gabi

Boopie, you live in Pasadena, what part??? Wow, what a small world. Yeah I transferred from Kaiser Nor Cal last year and apparently they cover it. I don't know why the two are so different...seems a little strange to me. When we do switch insurances how do we get our files from Kaiser...? I have never seen my file so honestly I don't even know what is in there. I have had them my whole life but for 25 years I had Kaiser Northern CA. I'm confused!

jmegirl, Do you live in Colorado or will this be a trip for you to go to this dr.? I am so nervous about my drs appointment tomorrow because I am afraid they are going to say that I don't qualify. I have no "diagnosed" comorbidities, but I have documented high bp and prediabetes. They didn't ever give me meds for them though. Is it sad that I did the calculation and it would only take an additional 20lbs to get me to a 40+ BMI. Who was your insurance through...I hope not Aetna PPO.

Good luck on your surgery, I bet you are soooo excited! Keep me posted on how everything goes.

Gabi

I live in NC, so I'm travelling for this. The roundtrip flights right now are about $240/pp and the hotel is about $120/night (staying 3 nights). So altogether we'll probably spend close to $11,000 - actually, probably a little more than that when you consider the prescriptions and all the liquids we have to buy for my 2-3 weeks of liquid diet. But it's all worth it!

I didn't even bother contacting my insurance company about this. I read the insurance literature I have about bariatric surgery, and it clearly lists the conditions I have to meet (none of which I meet) as well as the hoops I have to jump through. One of those "hoops" was an 18-month doctor supervised diet. I was like - HELL NO, I am not waiting another year and a half to get this done. So I convinced my husband to take out a medical loan, and we're doing the whole thing self-pay. We got our loan through www.surgeryloans.com in case you are interested.

69 days until my date with Dr. K.... :tt2: :thumbup:

Gabi311b Im actually from Altadena a little bit above Pasadena. Iwent To Eliot Jr High John Muir High And Pasadena CIty College. Ive been there for nearly my whole life. Parents still reside there, But now Im in the Valley, Tarzana. Um, I called Member Services @800 464-4000 and they were able to fax me a form that gave them permission to fax/mail me back my records, which Im gonna pick up today, I think after 10 pages its like 10 cents each or something like that. I actually have a dr's appt this afternoon, I thought I would be Band covered, but no. Its only for the folks who have Kaiser in No. Cal. So what Im gonna do is just shoot the breeze with my PCP and make sure all my records are up to par for transferring making sure I have my weight /bmi recorded as well as co-morbs and what ever else I can think of. Then as soon as open enrollment rolls around next month Im goin for UHC. Hope I was informative. Any more questions just let me know, and even though memb serv said they dont cover banding just gastric Im still gonna ask my dr one more time when I see him this afternoon. Ill keep you updated.

How did it go? I'm going this afternoon and I'm going to ask about the band as well. I go to the Kaiser clinic on Lake...we will see. When they say get records do they mean that you have to have a BMI of 35+ for 5 years or more of just a history of being overweight?

Gabs, Well my appt went ok I guess. My doctor was not familliar with the Bariatric Dept and the Lap Band procedure, but he did set me up an appt with the Bariatric Dept. So Im waiting on them to call me so I can ask further questions. I really dont think that they cover the Banding down here in So Cal. (Kaiser) only gastric. But hey its a try, and as far as BMI I asked about that, the nurse said when you get weighed they put your BMI in the computer as well, mines was like 43 so Im well over .Um Ive heard different stories about the weight vs. BMI documentation. But like I said your BMI should be on your weight history charts or at least in the computer. Regardless if Kaiser accepts this or not, Im gonna go to UHC if they dont and try that route, I cant afford it outta pocket, not during theses days and times PS did you call member services yesterday, if so what was the outcome? Lake/Villa Kaiser RULES!!!!

Haha, my appointment didn't go as well. My doctor said that I don't qualify for the referral at all. She said even if I did Kaiser requires like 50 weeks of a weight management class (only offered in Panorama City or South Bay) and if you miss one then you are out of the program. It is pretty apparent to me that I need to switch insurances or pay for this out of pocket. I ONLY weighed in at 252lbs and that wasn't FAT ENOUGH...are you kidding me? It made me sick...

I really hope your appointment with the bariatric dept goes well and I hope we can keep in touch and track each others progress.

Gabi

What do you mean you dont qualify. What was your BMI? And did she say that Kaiser did cover the Lap Band? Im totally confussed, and dont understand why you were turned down. And 50 weeks of classes WTF??? Thats a life time....:tt2: I really need a concreete answer if it accepted or not because the folks at Kaiser, I believe think Im referring to gastric, which I am totally not!!! Yes I definetely will keep in touch.

Boopie:regular_smile:

From what I gather, nearly every insurance company considers a BMI of 40+ as "qualifying" for surgery. Any lower than that, and you must have at least 2 comorbidities for them to consider you. I'm 5'8 and 250lbs and a 38 BMI, so I know I don't qualify as far as insurance is concerned, which is why I convinced my husband to put us into debt for a few years and self-pay for my surgery! :blushing: