88Shelly88

So I called my insurance company again and they told me that the procedure would need to be deemed medically necessary by my doctor. Has anyone had any expereince with HUMANA? Do they make you try other things first? To be honest with you besides a family history (mom, aunt, and grandmother being obese plus a dad with high colestrol) I have not had any other medical problems. I am just now starting to have sleep apnea (I think) and also knee problems. I am only 26 years old. Based on what I have found being 5'1" and 230 pounds I am MORBIDLY Obese. Do you think that I can qualify with just that? Is it hard for the doctor to convince the insurance co? I have my 2 hour consult coming up soon. :wink2:) I feel that I need this as I have tried everything to loose and just can not. (:pray2:

Hi everyone!! I am brand new here and just found this forum earlier this week in my hunt for every piece of information on the lap band that I could find. NOW I found the 20's thread!! YEY! So here I am, here is my story.... I am a 26 year old married mom of one. My son was born last May; he is the joy of my life along with my husband. I have always struggled with my weight since my teens. I would say that I was on the thinner side back when I was 17-18, looking back at pictures now. :pray2:( I wish that I fit in those size 10/12 jeans again. Once I hit 19 my weight poured on. I have tried everything from weight watchers SEVERAL times, a gym, a personal trainer, etc. On my third time rejoining WW I was somewhat successful in that I lost 21 pounds in 17 weeks. I felt so proud of myself and kept it off an entire year, only to regain everything back that I had lost. When I was going to the gym and working with a trainer I did not loose much and was working my bootie off. I got up every morning at 4:30AM and let me tell you I am NOT a morning person. I spent 1.5 hours a day sometime more, working out. I lost a few inches but never any weight. I know that what they say is true in that numbers are not everything. But when you are 5'1" and weigh 220 pounds at that point in time, numbers did matter. Especially after all the time and effort invested, every morning. It was very discouraging to say the least. I gave up after 7 months, and also gave up on the expensive gym fees. When having my son I only gained 15 pounds during my pregnancy, I assume that is because I am overweight as it is. I have not been able to get off that 15 pounds and now weigh around 235. My BMI is 43.3% A few weeks ago I was watching the discovery health channel and saw someone who had the LAP BAND surgery. I was amazed at the results and that is what started my weight loss quest. I started researching this and now I am hooked. This sounds like the perfect thing for me. I know that it is not a miracle pill or miracle weight loss. But I think that if I can have this surgery done, it will help me to achieve the life long goals that I have. To be a thinner, healthier, happier person. To be an active mom for my son and also future children. (I would like at least one more child.) My weight is finally starting to take a toll. My knees are bothering me, and I think that I have sleep apnea. Other than that I am healthy. No high blood pressure, etc. I am hoping that my insurance company (Humana) will approve me. I called them and was told that they cover weight loss surgery, etc. I know that several people have been told this to only be let down in the end. I have had people on here tell me that because I do not have a serious comorbidly that I probably will not be covered. So I guess that I am hanging on to the hope that with a BMI of 43.3, and a VERY LONG family history of obesity that I will be covered on that. I have also written a letter to the insurance co which was suggested on this board. (I was considering posting for thoughts on that too??) I plan on taking that with me to my 2 hour doctor consult. This coming Monday I am going to the one hour seminar and then have my 2 hour consult scheduled after that. Anyways, if you have listened to me this long, I thank you so much. I hope to make some life long friends here that know and understand how hard it is sometimes to be overweight. :wink2:)

Well I looked up my plan (while I am still waiting to hear officially from my HR dept at work on if my Lap Band Surgery would be covered or not) but this is a VERY small protion of what I found? What do you think?? Medically necessary or medical necessity means the extent of services required to diagnose or treat a bodily injury or sickness which is known to be safe and effective by the majority of qualified practitioners who are licensed to diagnose or treat that bodily injury or sickness. Such services must be: 1. Performed in the least costly setting required by your condition; 2. Not provided primarily for the convenience of the patient or the qualified practitioner; 3. Appropriate for and consistent with your symptoms or diagnosis of the sickness or bodily injury under treatment; 4. Furnished for an appropriate duration and frequency in accordance with accepted medical practices, and which are appropriate for your symptoms, diagnosis, sickness or bodily injury; and 5. Substantiated by the records and documentation maintained by the provider of service. Medicaremeans Title XVIII, Parts A and B of the Social Security Act, as enacted or amended. Mental disordermeans a mental, nervous, or emotional disease or disorder of any type as classified in the Diagnostic and Statistical Manual of Mental Disorders, regardless of the cause or causes of the disease or disorder. Morbid obesity means a body mass index (BMI) of 40 kilograms per mass squared or 100 pounds or more over your ideal weight as determined by the Metropolitan Life Height and Weight Tables for Men and Women, as of the date of service. THIS IS LISTED UNDER TREATMENTS NOT COVERED UNDER PLAN: 31. Services for the treatment of obesity;that is not morbid obesity (clinically severe obesity); I fall under the MORBID obesity as I am 5'1" and weigh 235, putting me at over a 43 BMI???

Thanks Kristin! I appreciate all of your good info. Since I am still new to all of this every little bit of info helps. I had no idea how much fills cost. You are right on using the McDonalds money for fills!! LOL or the profit from selling all of our bigger clothing!! YEY!

Kristin: So I am just curious (i.e. you replied to my post below) is your insurance company going to cover the fills, etc. Do they give you benefits in writing on what they will/will not cover? )

CONGRATS on the approval that is WONDERFUL!! Keep us posted!

Well I looked up my plan (while I am still waiting to hear officially from my HR dept at work on if my Lap Band Surgery would be covered or not) but this is a VERY small protion of what I found? What do you think?? Medically necessary or medical necessity means the extent of services required to diagnose or treat a bodily injury or sickness which is known to be safe and effective by the majority of qualified practitioners who are licensed to diagnose or treat that bodily injury or sickness. Such services must be: 1. Performed in the least costly setting required by your condition; 2. Not provided primarily for the convenience of the patient or the qualified practitioner; 3. Appropriate for and consistent with your symptoms or diagnosis of the sickness or bodily injury under treatment; 4. Furnished for an appropriate duration and frequency in accordance with accepted medical practices, and which are appropriate for your symptoms, diagnosis, sickness or bodily injury; and 5. Substantiated by the records and documentation maintained by the provider of service. Medicaremeans Title XVIII, Parts A and B of the Social Security Act, as enacted or amended. Mental disordermeans a mental, nervous, or emotional disease or disorder of any type as classified in the Diagnostic and Statistical Manual of Mental Disorders, regardless of the cause or causes of the disease or disorder. Morbid obesity means a body mass index (BMI) of 40 kilograms per mass squared or 100 pounds or more over your ideal weight as determined by the Metropolitan Life Height and Weight Tables for Men and Women, as of the date of service. THIS IS LISTED UNDER TREATMENTS NOT COVERED UNDER PLAN: 31. Services for the treatment of obesity;that is not morbid obesity (clinically severe obesity); I fall under the MORBID obesity as I am 5'1" and weigh 235, putting me at over a 43 BMI???

I am soo scared to call and be let down I guess. When I did call they told me that if it was medically necessary it was covered. How does it work for fills, maint.,etc. Do they typically cover all of that if the surgery is covered as well? I can say that I work for a LARGE corporation and the HR person that I am working with is great, when I had my son and had questions on my bills that I could not get anywhere with the insurance company on, she went to bat for me. Thanks dear! ) PLEASE PRAY FOR ME. I need this surgery!!

CONGRATS first and foremost. I wish that I were in your shoes. I have had a gall bladder removed and also a c-section. To be honest I was also SCARED to death of surgery. I balled my entire way into the surgery room for my gallbladder like a big baby. The worst part of that was the gas pain when I woke up. My sholders were killing me. My c-section also was not bad and I was awake, nummed up obviously. They have TONS of doctors in the room monitoring you so you will be fine!! ) Keep us posted. I am sooo happy for you!!

Welcome To The Boards!! )

Thanks so much Vessa for all of your great input. ) You give me hope and are helping keeping me motivated to under go this long journey!! :huh2:) Where will you be living in WI? I am going to see Dr. Jospeh Regan and he is with Columbia St.Mary's hospital. He is also the head of the surgeon team and looks like he has tons of band experience. I have my 2 hour consult in two weeks and I can not wait. How has the diet been? Is it hard to adjust to?

Well as I mentioned before I called Humana direct and they told me that if it is medically necessary from a dr. that my surgery would be covered. I kind of want to have some sort of validation and know what the ins and outs are. So I called our HR dept today and one of the HR reps is looking into this for me and is going to get back to me early next week. I can not wait please keep your fingers crossed for me, I really need to have this done for my health, sanity, family, and future. Thanks everyone!! P.S. Was I wrong in asking them to check everything out?

So I called my insurance company again and they told me that the procedure would need to be deemed medically necessary by my doctor. Has anyone had any expereince with HUMANA? Do they make you try other things first? To be honest with you besides a family history (mom, aunt, and grandmother being obese plus a dad with high colestrol) I have not had any other medical problems. I am just now starting to have sleep apnea (I think) and also knee problems. I am only 26 years old. Based on what I have found being 5'1" and 230 pounds I am MORBIDLY Obese. Do you think that I can qualify with just that? Is it hard for the doctor to convince the insurance co? I have my 2 hour consult coming up soon. :eek:) I feel that I need this as I have tried everything to loose and just can not. (:)

Well I am not in CO but I am in WI and I think that we have the all time record for SNOW and COLD! I hate the winter. I am looking forward to a skinny summer!! :cool:)

Hi Amy I am new here too! I am just getting started however and am looking into meeting with the dr for my two hur consult soon. Was it hard getting approved what all did you have to do?

So I called my insurance company again and they told me that the procedure would need to be deemed medically necessary by my doctor. Has anyone had any expereince with HUMANA? Do they make you try other things first? To be honest with you besides a family history (mom, aunt, and grandmother being obese plus a dad with high colestrol) I have not had any other medical problems. I am just now starting to have sleep apnea (I think) and also knee problems. I am only 26 years old. Based on what I have found being 5'1" and 230 pounds I am MORBIDLY Obese. Do you think that I can qualify with just that? Is it hard for the doctor to convince the insurance co? I have my 2 hour consult coming up soon. :cool:) I feel that I need this as I have tried everything to loose and just can not. :eek:(

Hi Everyone. I am BRAND new here!! :smile:) I found this site in doing a web search on the lap band surgery. I am contemplating getting banded and feel that this is the right decision for me. I am 26 years old, 5’1” and weigh 230. From what I have calculated I have a BMI of 43.3%. I have been struggling with my weight for the last 8 years now. I have tried everything from Weight Watchers, in which I did loose 50 pounds, kept it off one year and then gained it all back. I have tried the gym, and even spent $2,000 on a personal trainer. I feel that this is my only last hope in this battle. I found out that my insurance covers this procedure and now am more excited than ever. I am not sure quite what the logistics are or if it will be a pain to get the coverage but they told me that they cover weight loss surgery, etc. I am going to the informational meeting this coming Monday. I am just wondering who else is looking into this and what others experiences have been with insurance. How has the lap band worked for you? The only part that I am scared about is the diet afterwards. Do you still have the cravings that you did before hand or do you not have the desire with the shrinking of your stomach. I plan on really watching my diet after I have this done, as from what I can tell you pretty much have to. My spouse is 100% supportive do you think that he should come to the meeting with me to get a better understanding of the procedure or can he just come with me to a dr. appointment before hand? I am sorry that I have so many questions!! Also one more thing. Is there typically a waiting list for this? Why did you choose the lap band over gastric bypass?