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Okay bear with me here everyone but here is word for word what they have written on BCBS website: The first treatment of morbid obesity is dietary and lifestyle changes. When conservative treatment fails, a few patients may require a surgical approach. A 1991 National Institutes of Health (NIH) Consensus Conference defined surgical candidates as those who meet the following criteria: Patient has a BMI of 40 kg/m² or greater than 35kg/m² in conjunction with severe comorbidity such as cardiopulmonary complications or severe diabetes Super obesity described as BMI >50kg/m² Failure of sustained weight loss with supervised dietary and conservative treatment over the years Motivated individual with acceptable operative risk Surgery for morbid obesity, also known as bariatric surgery is based on intestinal malabsorption and gastric reduction. Surgery is considered successful if weight loss is maintained at greater than or equal to 50% of excess body weight for more than 10 years. Prior Approval is recommended for this service. Submit a prior approval now. The following surgical procedures for the treatment of morbid obesity may be considered medically necessary when the criteria for coverage listed below are met: Vertical-banded gastroplasty Gastric bypass (Roux-en-Y gastroenterostomy); this can be done by both open or laparoscopic approach Adjustable gastric banding (Lap-Band® procedure) for patients with a BMI less than 50kg/m² Criteria for Coverage: Patient is at least 18 years oldAnd The patient must have a documented medical history of failure to sustain weight loss with medically supervised dietary and conservative treatment for at least three years including within two years preceding surgery. Medically supervised treatment consists of physician documentation of the assessment of the patient, what health interventions are prescribed and their on-going assessment of patient's progress toward a goal of weight loss or control of an obesity-related comorbidity.And The patient must be a motivated individual with acceptable operative risk and must be evaluated by a licensed mental health provider to determine the patient's willingness to comply with pre and postoperative treatment plans, and a strategy to ensure cooperation with follow-up must be documented.And, in addition to the general requirements above, the patient must also meet one of the following weight criteria: BMI of 40kg/m² for at least 3 yearsOr BMI of greater than 35kg/m² in conjunction with at least one of the following:Hypertension requiring medication for at least one year Diabetes Mellitus type 2 requiring medication for at least one year Obstructive sleep apnea, confirmed by sleep study, which does not respond to conservative treatment Documented cardiovascular disease Pulmonary hypertension of obesity Or Super obesity described as BMI greater than 50kg/m² for vertical-banded gastroplasty and open or laparoscopic gastric bypass (Roux-en-Y gastroenterostomy). The following surgical procedures for the treatment of morbid obesity are considered investigational: Adjustable gastric banding (Lap-Band® procedure) for patients with a BMI equal to or greater than 50kg/m² Mini-gastric bypass (laparoscopic) Biliopancreatic bypass with duodenal switch Laparoscopic silicone gastric banding Biliopancreatic bypass (Scopinaro Procedure) Subsequent bariatric procedures, including revisions, in patients who regain weight due to failure to comply with lifestyle or dietary modifications are considered not medically necessary. Okay so if I'm reading this right to be covered for the lap band I have to have a BMI just under 50. Also the part where they talk about needing to have tried and failed doctor supervised weight loss efforts for THREE years!!! I haven't really had any doctor supervised stuff, at least not for a really long time. Other than with both of my pregnancies I had gestational diabetes and obviously had to follow the diabetic diet for both my health and that of my babies. I did lose forty pounds or more during each of my pregnancies and then within a matter of about two or three months I gained that amount back and more both times. I don't know if that would count but I'm guessing not. I do know that our hospital is now offering this six month weight loss clinic thing where you work with the dietician,doctor,and trainer. In the literature I read for it it says that it usually satifies most insurance companies rule for having doctor supervised weight loss efforts. Do the insurance companies really stay strict about the having shown you've tried losing weight with the help of a doctor? If so that sucks because if that was the case I would've been doing something about it with my doctor and not just on my own. The thing is a person can only see the dietician so many times KWIM? I know what I should eat, I just can't stick to it or I wouldn't be in the shape I'm in. UGH, I am soooooo upset. If I have to wait another three years I'll be devastated. Has anyone gotten around that? I just wish I had realized this.

Great information guys. Actually my insurance says something like the band is investigational or something like that for anyone with a bmi of either 50 and up or over 50. I can't remember 100% what it said but I am almost positive it was for 50 and up and then for that they won't cover it. I guess I need to just suck it up and give them a call. Will they actually give you a list of doctors too?

I've posted a few times now but I'm confused as to exactly where is the best place to start on my journey towards the band? I have an appointment coming up with my family doctor that I already had for a med check and I plan on bringing up the idea with her. But I'm wondering do I contact my insurance company first? I looked up on their website and from what I can see they do cover the band if you have a BMI of under 50 (mine is 50 but I'd only need to lose 5 pounds to lower it). I've found a doctor about 2 or 3 hours away that has done a ton of bands and I'd like to possibly check out one of his seminars. But someone mentioned on another of my posts to see which docs my insurance will cover first. So how do I go about doing that? Do I just call up my insurance company? I just get nervous dealing with them because I'm so afraid of being denied. I'd love to hear from you all as to which steps I should take first. I feel like my wheels are spinning but I don't know where to go. It's gotten to where I can't sleep at night with thoughts of this all. Right now it seems just out of reach if you know what I mean. I feel overwhelmed. Thanks for all your help so far, you guys are great!!

Is anyone familiar with Dr Obrien in Sioux falls SD? On his profile on obesity help it says he's done something like 530 bands. That's WAY more than anyone else I've found. The only thing I noticed is that he doesn't have a therapist or whatever you want to call it on his staff. I guess I have one anyway but I thought that was strange that they didn't have one as it seems most that I've looked at have. Now I'm just wondering if I should contact his office or wait till I see my physician in a couple of weeks. ALso wondering, is it a bad idea to call insurance and ask them exactly what they require to quailify for the surgery. I looked up on their website but I just want to be sure.

Thanks for the info guys. I just wasn't sure if it was best to get the fills done at the office with the staff that originally worked with you. I would assume it is. Plus I live in a pretty rural area, even what's considered the bigger towns around here aren't so big. I hate to be negative but I haven't found the medical care here to be as good as when I lived in a larger city. Of course that's not true for everyone hear because I have found some great doctors, just overall I guess. I can't wait to talk to my regular physician about this and see what she thinks!

I have BCBS Alliance Select in Iowa. From what I've read on the company website lapband is covered if you have a BMI under 50. I'm at 50 but I think I can manage to lose 10 pounds to bring that down. Anyhow I know every insurance is different but if they say the procedure is covered does that usually mean your fills too? Or is this something that might be all out of pocket? I'm just realizing that this surgery is really something that could require quite a few visits and I just would like to know what I'm in for I guess.

I guess I'm confused about the whole fill thing in general. Is the actual surgeon the one doing the fills? If not who the heck is? I think I may have found a potential doctor who's 3 hours away. Is this who I'd most likely be going to for fills and whatever else I may need?

Okay I think I got ya now. So it's not a complete fantasy to think I could lose say 90 or 100 pounds? Of course this is all depending on me I know. But you know although if I could be a "normal" weight again that would obvioiusly be ideal. Like you said though even if I had to still be heavier than ideal, if I wasn't gaining that would be a huge accomplishment alone. I think I've just sort of got to realize that there's no real "rule" when it comes to how much you can expect to lose. That scares me. It all comes down to failure pretty much. What if I go through all of this and lose 10 pounds or worse than that gain 30 or worse than that die of a complication. As you can see I'm a pessimist. Like everyone has said though, things are already bad. I know I'm going to end up diabetic and that just kills me, mentally and literally. Plus my quality of life is so low. Not to mention what my kids are missing out on because of my limitations. I just keep hoping I'll have this sort of "lightbulb" moment where I'll know 100% that this is absolutely the right thing to do, I don't think that could happen for me though. You know my daughter just went through losing my mom her beloved Grandma who lived with us through my daughter's entire life. They were best friends. My little girl is going through some pretty serious emotional issues right now stemming from that loss. I'm so afraid that because I'd have to go this route that I might die from it. Now of course I know if I don't do something I'll die sooner or later anyhow. But the thought of leaving my kids because I couldn't lose the weight on my own. Oh my god it breaks my heart. I know that there isn't a huge mortality rate, but still like I said I'm a pessimist. I just need to somehow get past this but I'm having a hard time. I'm telling you I can't make a decision about anything without having major worries about it. What was it for you all that really got you over the hump of "what if's" and moving on?

Wow. It's nice to hear that I'm not the only one with these feelings, but then on the other hand it's so sad that so many of us battle with this. Actually what Jachut said about not being hesitant about fixing some other part of us really hit home. I've had problems with depression and there's a lot of mental illness in my family. Some have choose treatment, others have not. I've tried and tried over the years to help those who have choosen not to seek medical help what a huge difference it has made for me. Before medication my life was so much different. It's not perfect now but it's so, so much better. I only wish that some of my loved ones would undersand that your brain is no different than your heart or your knee or whatever. If it wasn't working right we'd do whatever we could to get it in the best condition we could. I don't understand why so many people feel ashamed to seek help for mental illness but they do. Okay so why in the he!! do I feel so ashamed for seeking help with my obesity. It's debilitating, it's completely ruining my life. I realized years ago that I couldn't just "make" myself not have depression and anxiety issues so why can't I just see this for what it is then? Maybe because all my life I've been told that there's nothing worse than being fat. That if you are fat you are worthless and loveable. I guess after years of that being force fed to ya you believe it. Somewhere inside I know that I shouldn't be ashamed of this. However I haven't been able to come to a point that deep down in my heart I truly believe that. I think that's what's got me wondering if surgery would be right for me. I'm so, so afraid that something will go wrong or I'll fail. I simply cannot imagine that. I don't know what I'd do. On the same token imaging the rest of my life at this weight is beyond sad...it just makes me feel utterly hopeless. By the way I'd just like to bring up something that irritates the he!! out of me. On one of the morning shows today they had some women who all lost 100 pounds or more.......WITHOUT SURGERY!!! They had to make that a big issue because god forbid some fat lazy a$$ person would need surgery to do it because then you took the "easy" road. Anyhow don't get me wrong I am truly happy for these people and wish them the best in the world. But what gets me is why do they not ever bring these people back in a year,2 years, 3 years to see how they are still doing? As most of us know we can lose the weight, it's keeping it off that's an even bigger struggle. God forbid any of us have to choose GASP surgery for our weight problem. Geesh can you tell I'm having an emotional day?

I'm so confused as to where to begin looking for a possible surgeon. I live in North Iowa way up near the Minnesota border. I've looked on obesity help and wasn't impressed with the number of bands that many of the doctors within a couple of hours of me have performed. That said I really don't want to drive hours and hours either. But I'd really really like someone with more experience with this particular surgery. Where can I look up to find how many of this surgery a doctor has performed? I was confused because on Obesity Help some of the docs profiles said they did the band but then it didn't say a number of them that they had performed. By the way my hometown is Rockford IL. It's about five hours from here and anything in that vicinity wouldn't be too bad for me because I know I have friends and family that my family and I could stay with while there if we needed to. Is anyone familiar with any docs in that area? I'm just not sure where to look next. I really want to find a possible doc and attend a seminar. Just not sure where to find more doctor information. Thanks for all your help so far by the way, you guys are great!

Oh my gosh, how great it would feel to really work out again. Okay I've never ever enjoyed exercising. But I will never forget the high that I'd have afterwards. I will never forget how it was to feel strong physically. That was a great feeling and so worth working for. It's funny it's hard to think back to the days when my body was strong and fit and to think that was really me. I couldn't be more opposite now. At this point my body is just a big fat unhealthy blob. I feel weak and tired and simply don't have the energy to really fight, at least that's how it seems. Every single night lately I'm up and can't sleep mulling this all over. Every night I know that tomorrow is a new day and I can start again, that I have done it before and I can do it again. But I'm so tired of the fight. Does that make sense? I think I'm just going through this mad stage of being angry that it has to be this hard for me. I know it is for some of us, but why. That doesn't matter I know. It's how we choose to deal with it that's important. Can I ask you this? How did you make yourself feel like you were worth it? I mean I know I'm worth saving. But at the same time I feel like I should be able to do it without surgery if I really want it bad enough. What's that about? I'm assuming others go through this mentality but I just don't know how to move past it.

Wow, this is weird but just like another reply you gave me on another post you really summed up how I feel. What you said towards the end about the band not being about dieting. About food being what it is, food. Nothing more nothing less. That is exactly where I'm striving to be. I've been going to therapy to try to understand why I've done this to myself over the years. The cycles of starving and gaining back and then some have left me so fat and so unhappy and empty. I'm at the end of my rope and I don't want to be battling this anymore the whole food thing. I definately have a huge problem with the whole head hunger thing, but I've also always had a problem with never really feeling full either. My best friend has always been the same way. However for better or worse she's been able to just pretty much swear off food down to the bare minimum she needs to live. She's a size 2. But since we were little girls we'd always have this thing where it was like we could eat and eat and eat. We always thought we were the only ones then, boy were we wrong. Interestingly enough though we both grew up with Moms with huge food and body image issues. Coincidence? Probably not but who knows. I'm just worried that I'm hopeless and nothing will help. I feel like I want to lose weight more than anything. So I feel like if that is the case I should just be able to do it myself without any help. And truly it would be hard but I could do it. The trouble is just like before I would gain it back and then some. I simply cannot handle the heartbreak and embarrassment of that again. So I'm just wondering if this is actually something that could help for someone like me. Thanks for your posts by the way, I just can't believe how much what you say is exactly what I'm thinking but cannot seem to say.

Jachut- What you said at the end of your post about why would someone go for the surgery and still be in the "overweight" category...that is exactly my point. I DON'T want to do that. That's why I'm trying to understand exactly how they are figuring excess weight. My point was that I would never go through all this to still be 220 something pounds, no way. Yeah it would be okay but not to have to go through all of this. Would I want to even be 180, no but it would be a heck of a lot healthier than my once 280. That said trust me that I haven't been obese all my life. I bounced around between normal and chubby for my high school days for the most part. And when I got down to 119 pounds I was thin. Was I Nicole Richie thin, no. But there was no doubt about it I was thin and in great shape. I was usually in a size 6 then, sometimes smaller. I don't know if I'm wrong here but that's not big in my book. Now trust me when I tell you at 90 something pounds I would be sickly, not healthy. In high school my sort of "natural" weight were I could eat most anything I wanted and not worry too much was 160. That's where I got a bit chubby. Think like Kate Winslet in titanic or maybe Liv Tyler. Not fat at all, just not trim and in shape like I was at 119. I just wanted to make sure I made it clear that I understand that 220 something isn't healthy, in fact that's my point. I'm wondering and hoping that when I read "excess weight" they are referring to the difference between me at 265 and my suggested healthy weight range of 90-100 and something. Does that make sense? I guess what I'm trying to say is that I don't want to even think about it if I don't have a good chance at getting back to a "normal" weight. I would love to be a size 5 or 6 again. But at this point in my life my priority is to be able to feel good and live life again. I could easily do that at 160, even though the charts would still consider me obese at that weight. I've been there and done that and I know that it was a healthy weight for me. So if I'm supposed to weigh say 130 pounds at the high end...then that's 135 pound difference of excess weight correct? Then I could expect to lose roughly half of that? Which would be about 67 pounds, is that right? I hope I'm not coming off as snappy because I don't mean to be at all. Actually you are saying exactly what I'm trying to say (does that make sense). Again, I would be much happier and healthier losing 67 pounds. I guess I was just hoping I could expect to lose more. Is that possible, more importantly is it realistic? BTW-Towards the end here did I get the excess weight thing right? Sorry to be so confusing here guys. Thanks so much for hanging in here with me, your help really means so much!!