loseit7

The first doctor I went to became completely unsupportive when his office found out that my UHC policy requires a BMI of 40+. I have a BMI of 37 with two co-morbidities so I know I will eventually be able to get approved. Even my HR department just said "send in a letter of medical necessity and it will go through." So anyway, I'm hoping to find a Dr. whose office staff is ready for a little fight and doesn't panic when things aren't going to go super easy!! I've read good things about Dr. Ferrari on another site, but haven't seen too much about him on here and I have come to really trust/appreciate everyone's opinions on here! Any info would be appreciated. Thanks!

Yes, I did go to Dr. Ferrari, but I ended up getting gastric bypass instead of Lapband. He is great! He's not the most talkative fellow out there, but he is an extremely good surgeon and his follow-up care is great. Any questions/problems I have had have been immediately answered. I also had to have my gallbladder removed last month and he took it out the day after I went into the ER instead of having me leave the ER and schedule the surgery (which can take weeks and when you are having gallbladder attacks weeks can feel like months!). Good luck in your decision making!! Also, he has lots of patients over on obesityhelp.com and there are a lot of quotes from his former patients on his profile there.

I had signed up for an upcoming "free" seminar with Dr. Spiegel's office some time ago (before deciding on a different doc) and today I got my reminder call telling me not to forget to bring my $200 "co-pay" for my seminar and consultation. Oh, and payment for my "free" seminar would only be accepted in cash or money order! :eek: This cracks me up for some reason. Probably because 1) my insurance does not have any co-pay's for anything, so calling any payment I have to bring a "co-payment" is highly misleading and 2) I checked on his site again today and it still says this is a FREE seminar. Do all the docs that run these seminars end up charging you something like that? I mean, on one hand I can understand that they want compensation for their time, but I think they should be honest about it and not claim that they are doing it for free.

I just wanted to give y'all an update because I am so happy I can barely contain myself. I have been going back and forth with my HR department trying to get them to drop the BMI requirement back down since it was covered last year and they have just sent me an email telling me that they are going to update UHC's system to reflect the fact that WLS is a covered benefit with a BMI between 35-40 with one co-morbidity!!!!!!!! So happy I can't take it! :biggrin2:

I called UHC last year and the surgery was covered with a BMI between 35-40 with 1 comorbidity - no diet required, no nutritionist required, no psych eval - just five years of being severely obese. So I waited until the start of the new year and went to the doc who says I'm the perfect candidate. I call my insurance today to ask them my list of questions and BAM!! I'm told that you have to have a BMI of 40 or above with 5 year history of being morbidly obese (not just severely) and there is no comorbidity exception for lower BMI's. So am I screwed? Is there no way to get it covered? And if not - does anyone know of a place where a person with horrible credit can get a loan to pay for this?!! Urghh - I'm just so frustrated. I thought I had this in the bag and then to have the rug pulled out from under me like that just sucks!

I read an article that said a very high percentage of potential lap-band patients that are turned down based on their psych evaluations, were turned down because of being "emotional eaters." So if you eat when you're stressed or sad, then that may be a red flag to your psychologist. I think because if that's the kind of eater you are, it makes it more likely that you will figure out ways to "stress" eat with the band in place. I think that article was on WebMD, but I couldn't find it to put the link in here. But I'm sure if you search through the forum you'll get more feedback on this. Good luck!

It varies by plan, I think. If you go to myuhc.com and start an account (if you don't already have one) you should be able to go to the "My Benefits" section and click on the "Out of Pocket Maximum" link and it will tell you the definition specific to your plan. But, generally speaking, your deductible does go towards your out of pocket maximum, so you would pay a maximum of $2,000 for the surgery I would think.

I am still in the hoping and praying stage of all this, but I have told a few people that this is what I want to do. My dad and my husband were the ones to bring the diabetes statistics (about how successful lapband patients are at getting rid of their symptoms) to my attention, so they are both totally supportive. Then my mom, two good friends and my boss know. My boss only knows because I felt she deserved an explanation for all the doctors appointments and she is SUPER supportive. I don't plan on telling anyone else until I actually have the band done. At that point, though, I know I will tell anyone who will listen because I have a tendency to "overshare." :eek:

I wish they gave these people's measurements like they do on the Discovery Body Challenge (or whatever it's called). There was a set of twins on that show this past season that had real similar weights to me and I was sitting there saying "no way" because they were so big and I KNOW that I am not that huge. My husband was sitting there with me and he was also saying no, it's not possible that they're the same size as you. So then they gave their waist measurements at the end of the show, starting and ending, I went to measure myself so I could compare it to their starting waist size and that is when it happened.............I am bigger than the biggest twin by two inches!!!! Aaaaagh!! I of course had a major melt down and a huge pity party, with my poor husband sitting there saying "you still don't look that big, I don't care what the tape measure says." The next day I finally made up my mind that I was going to change my life and get this lap band!

Thanks so much for all your replies. I feel a lot better about the situation now. If this doctor that I went to recently doesn't want to pursue it, I will just have to find another doctor who is willing to help me fight. I'm in Houston so there are a LOT of doctors to choose from! Thanks again for all the encouragement!

Congratulations on getting the surgery! I have actually thought about doing that, but it would be 20 pounds in my case and then it still says you have to have 5 years of being MORBIDLY obese. I think morbidly means a BMI over 40, so I still woudn't qualify. I'm just still reeling from the fact that four weeks ago diabetes and a BMI of 35 would have been enough and now it's not covered! And the worst part is that I had a freaking appointment in mid-December but didn't end up going because of all the Christmas stuff!

Thanks for the encouragement! That's really what I started thinking - I mean what else am I going to be doing for the next three months of my life? I'm planning on just staying the course, doing everything the surgeon wants me to do, and then just seeing what they say. I've also contacted my HR department to see if maybe it's just an oversight...it's possible! My company did a complete overhaul of their benefits for 2008, but I really don't think they were changing coverage, they were just changing deductibles. Anyway, I'm keeping my fingers crossed!

I have a BMI of 35 and was told by my insurance (UHC) that the surgery would be covered as long as I have "other conditions". I have pre-diabetes and insulin resistance, but I have never been treated for either. My OB/GYN did a full blood workup a few years ago, then when the sugars came back high she had me do a glucose tolerance test. Both tests showed my sugars about 9 points away from diabetes and my insulin levels were super high. All I got from her was a little note that said "It's NOT diabetes". It wasn't until I looked up the numbers myself that I found out they were all out of whack. My question is has anyone else here ever had a similar situation and had insurance approve right off if they can prove the sugar/insulin levels are in the abnormal/dangerous range, or did you have to undergo a period of treatment by an endocrinologist for a period of time before approval? In addition to the sugar/insulin thing, I also snore like a freight train, get heartburn about three times a week (so bad that I throw up sometimes) and have high blood pressure. I guess I'm just borderline on the blood pressure thing - every time I go to the doctor they end up taking my blood pressure four or five times to make sure of the level. The last time I went to my PCP she gave me a diet to follow in an attempt to bring it down. My first appointment with a surgeon is next week so I guess I should just be patient and wait till then, but I'm just so anxious/excited now that I've decided this is definitely what I want to do! Okay, sorry for the long post. Any advice/information/guidance you could give would be greatly appreciated!

That's a great idea. Thanks!

Hello all! I have been reading the boards for the past couple of days and I think it is just wonderful how much good information is on here! I am just starting the process - have an appt. with a surgeon next week - and this forum has been really invaluable. I'm hoping that insurance (UHC) will pay for my surgery, as I have a BMI of 35, but also have pre-diabetes, borderline hyper-tension, high cholesterol and reflux. Unfortunately, I am not being treated for any of these things - I've never had a doctor who thought any of that was too big of a deal, I guess. But who knows what the insurance will say - all I know is they told me it would be covered at 100% if I had a BMI between 35 and 40 with other conditions and a weight problem lasting at least 5 years...um, yeah, I've got that. So thanks to anyone who read this! I am enjoying reading through all of your posts, gleaming whatever information I can from them. Good luck to all!

Nothing to teach you - I'm only just starting the whole process, but I just wanted to say congratulations!! Keep up the good work!

Anyone here used him or have any information on him? Just looking for some guidance. Thanks!