Hi all,

I just got back from Houston, with my consult with Dr. Spivak...The nurse and insurance person there were absolutely positive that BC/BS would NOT pay for my band. :cry My BMI is 34, and I both of my knees have been paritally replaced. I even had my orthopedic surgeon write a letter that if I lost 65#, which would put me at 150, it would be very benifical to my osteoarthritis. I take two medications for GERD, high chol. high tri. etc...but none of these, I was told, were considered life threatening. I don't have asthma, or sleep apnea, etc. I know, I know, I should be counting my blessings that I don't have these things, and I do...but I have had my heart set on this procedure....already paid for the psy. and nutrition eval..for nothing..$275.00)

So, I will have to be a self pay....and I don't know if I can put this kind of money on myself...I am afraid it would be a burden on my family. But, very good friend, Kim, who went with me, and is having the band done also...told me to pray about it. If God says it is OK, then nothing can go wrong. That I will find the $ somewhere.

I don't mean to whine....really... just a little bummed out today.

By the way, the office staff, and Dr. Spivak are awesome! Very pleasant and caring people. Praise God for that.

Ya'll keep up the good work, I am proud of all of you!

Lu Ann, I think your friend Kim has given you great advice.

As far as being a burden, I faced the same thing. Here I go spending 10K+ on band surgery (with airfare for 2 and expenses, etc) and I'm paying a measly $200 a month toward the home equity line of credit. So I have our family in debt and I'm a stay-at-home mom budgeting the grocery money with my band payments. I fight the guilt, believe me. However, I have lost 17 pounds so far (time for a fill) I feel better already, I'm happy, confident that I will get the rest off, our sex life has improved (wahoo!), my stamina is better in all areas, and now that it's done I feel as if I am moving forward, not stuck. So, the guilt is definately managable

So you already have a great doc who has a reasonable self-pay price tag. Pray, seek God's will, and step forward until HE says stop. See what happens. Bless you!

LuAnn are they even going to try to submit it?? I would at least wait to find out what the insurance says before losing all hope...

They are still going to submit it, but she was 100% sure they would deny it. "All things are possible"...so I will keep praying.

Thanks for your words,

Hi all,

I just got back from Houston, with my consult with Dr. Spivak...The nurse and insurance person there were absolutely positive that BC/BS would NOT pay for my band. :cry My BMI is 34,

...at my height, the difference between a BMI of 34 and a BMI of 35 (which, with your comorbidities ought to do it) would be:

•a medium to large bag of potato chips the day before the exam. That salt would cause me to retain enough weight...which, at my height, is only five pounds...to move me from 34 to 35.

•I'd skip my morning diuretic...to retain yet more fluids.

•and, I don't know the condition of your reproductive system, but there are days some of us weigh more than we weigh on other days. You might want to schedule the exam for one of those heavy days.

Sue

:::doing my part to legally use the system as it is:::

Returning to add:

LuAnn, I wouldn't let them submit with a BMI of 34, until I read my insurance coverage. If the criteria is 35 with comorbidities...I'd wait, seriously, until after a bag of chips and all.

LuAnn,

Heck, if you must pay cash, just think of it as a car note! This surgery is around the same price as a car......

Keep trying - keep trying -keep trying! It will all happen when its meant to happen. I know this for sure!

Hello,

I'm dont really have any good advice just that im going throught the same issues. I was told by the insurance rep at the hospital that throught my employer i will not be covered they have a written exclusion. I was actually willing to self pay but my credit is to bad and its all old credit issues. This is when you wish your family was rich. Im not sure what to do. but i wish you the best of luck and pray that you are able to have your surgery.

Lu Ann,

I am only researching before banding and read your post. Just think what kind of burden there would be for your family if you weren't there to care for them....weight is a killer also besides many other conditions that you wouldn't think of twice taking care of reguardless of cost....what is the cost of having a great mom and wife? YOU ARE WORTH MANY DOLLARS....Good luck in your quest.

Jerraly

I had the same concerns for my daughter. My insurance company rejected our request for the lap band, I think primarily because of her age. Her BMI was over 50 and she met all the other criteria but because she was 17 they said no. She didn't want to wait any longer and I had to make a decision like the one you are trying to make. I'm a single mom, with my daughter and son and decided to do what ever I could to save and change her life. I worry that I'm taking away from my family but I would do it for my son if I needed too. Good luck to you with your decision and remember you are the mom and where would they be without you........

Thank you all for your support. I do feel better about it, and I am going forward with the band.

Way to go LuAnn and good luck. My daughter's doctor is Dr. Spivak also and he and hiis staff were great. Let us know what happens.