Here's the question: could I be rejected for the surgery because I’m “socially disadvantaged?”

In reading up on the eligibility criteria from a few different places, I kept coming across something about how part of the accept/reject decision is based on the victim…er…”patient’s” support system.

I don’t have a support system. Nobody. Nada. Oh solo mio, etc. I Rarely speak to my family. My few friends live on the opposite coast. My HMO is really being a pain in the butt, so I have decided I’m going to do whatever I have to do to get approved by my PPO. Does anyone know if this “support system” thing is make or break? Because while I’m not to thrilled about lying, I’m fully prepared to tell the doctor I’ve got a loving boyfriend, I live with my four siblings and we all get along perfectly, and my parents live across the street.

Has anyone had to deal with this?

Sleepyjean, there is absolutely NO WAY IN HELL any carrier could use any of that in making a determination about whether banding is medically necessary and whether they will pay for it.

Just curious: how is it that you have two different kinds of coverage?

ETA: It occurs to me that perhaps your doctor may care whether you have a support system in place, and that may influence his or her request for precertification and the terms in which it is couched. So sure, if the subject comes up, go ahead and tell the doctor that you are fully supported in this endeavor by all your friends and family. That's all they are likely to want to hear, anyway. I mean, they really don't care if you're popular or not.

Well....I was self pay, but like you I have no support system. I live 1200 miles from my parents and wouldn't tell them anyway about this surgery. My bf of seven years broke up with me last year and I've no one I'm really close to in the area. I had to ask my doctor if there were issues with me doing this alone and caring for myself afterward alone. He said no. The only issue was that someone had to drive me home from the hospital (due to residual anesthesia).

I paid for a plane ticket for my sister to come down for a couple days but she had to get back home to her twin boys. She got there the day I was released from the hospital. I did the rest of it all on my own.

It can be done alone. However, if insurance is basing a decision on THAT (which I think is absurd), then my name is Karen and tell them I'm your best pal and I'll be there for you from start to finish. Yeppers, I'm your support network.

Any other "best friends" around here? Betcha you've got a ton of us who you can honestly say are your support team.

Go get 'em, tiger.

Hey Jean, I will be your support friend. My name is Keri. I don't even remember if anybody asked me if I had a support system or not. It wouldn't have mattered...I could have easily done the aftercare myself. That is what God made Taxi's for. Best of luck.

Of Course You Have A Support System. You Have Us !!!!!

Um, Guys - I think LBT counts as Support System... And if you have local meetings of banded people in your area - this also counts as support system. Friends count, too.

IF you have someone to drive you home from the hospital, and someone lined up to watch your kids - then YOU have a support system.

Your surgeon and your PCP are also part of your support system.

You don't have to have relatives to have a support system.

:]

I hate to bring down the house.. but my psych eval was based on who was my support system. Afterwards she todl me that is exactly what they are looking for.

However.. i used LBT and she totally loved the idea.

Is there any local support groups?

LBT is my support system. Others in my life are certainly supportive, but band stuff is here. I'll support you! Kathy... best friend...has been banded 6+ months. She's really nice and helpful...lol!

Cindy here, yep, another supportive friend of yours. I am unemployed and totally available to fly to where you live? and take care of you afterwards. You have tons of friends, they don't have to know that they communicate with you through the computer, but this is the computer age and everyone does it. Heck people even meet their future spouses, partners, loved ones over the internet, what's the difference if your support group is here?

Keri's right, just call a cab if you have to to get home. I have a very close friend, my best friend as a matter of fact, who lives in the same condo building I do. But he's a guy and the most support I got from him was the ride home, the rest was all up to me. I'm not complaining, I had it really easy, so it was no big deal and if I really need anything I would have called him.

Remember to jump those obsticals they throw at you or if you can't jump them, go around. Whatever you have to do, just get past them. This is for you and I don't think anyone has a right to take it from you.

Good Luck!

Cindy

Thanks so much everyone. It helps to know what others had to do. :-)And I definitely feel less alone in this. I hate having to explain to a doctor I’ve never seen before why I’m friendless and alone. It’s not that I’m some weirdo or people phobic, it’s that I moved here three years ago, and was too embarrassed by my weight to get out there and meet people. I know I am an extreme case and there are plenty of fat people who go out there and live life to the fullest. But there are also plenty of people like me and people (doctors and such) who have never been obese just don’t get it.

Alexandra: I have 3 tier health insurance with healthnet, so I can choose to do HMO with them, PPO with doctors in their network, or I can do my own thing.

Cindy – do you live in L.A.? LOL

Well, doesn't it just figure, I live clear across the country from you!!! I live on the East coast, Miami, FL. You know, the place that's about to be hit by yet another hurricane this year. I am so over these stupid hurricanes, major inconvenience ya know?

I wish you luck with the doc, insurance and with the soon to come surgery!

Keep us posted on how things are going.

Cindy

like aaamom says - you have us. Explain to whoever may ask you that you have developed a great support system through this site.

Also - my doctor has a lap-band support group made up of his patients. We meet once a month. It is very helpful and I wouldn't miss it.

Maybe your docs will have such a program also.

Good luck and remember - you have us....by the way, nice to meet you - my name is Nancy and I was banded July 25, 2005.

As both a banded patient, and as a Psychiatrist who has done pre surgical evaluations for bariatric surgery I would never disqualify a patient based only on their support system, thats nuts! I do agree that support is important, but I would defintly count LBT as a support system, also don't forget about clubs, church/synagoge/mosque

Benet

We are your support system, absolutely. We can get you through this whole process, and there has to be someone on this board who lives in LA. If not, I am in San Francisco and if it doesn't conflict with my ridiculous work schedule, I'll come down and drive you home myself!!

I hate having to explain to a doctor I’ve never seen before why I’m friendless and alone. It’s not that I’m some weirdo or people phobic, it’s that I moved here three years ago, and was too embarrassed by my weight to get out there and meet people.

Sleepyjean, if the doctors you're dealing with have lots of bariatric patients, I promise you they've seen this before. Morbid obesity causes social isolation in LOTS of people, and that's one of the reasons it's unhealthy. No one will hold it against you.

With regard to your insurance, if both types of coverage are with the same company their medical decisions may be the same. But it's great that you have choices and I hope you prevail!