Claytaco

These are the qualifications for lap-band surgery with UHC as I know them….. A benefit for bariatric surgery related to morbid obesity. BMI of 35-39.9 with two or more health problems associated with patient’s weight. Or BMI of 40-above without health problems associated with patient’s weight. 5 years of medical records (one medical encounter each year showing that your BMI is within range above). Some out of state or unusual plans can require fewer records. Diet and exercise for six months under the supervision of your doctor or bariatric clinic. Everything else you need, you get at your doctor’s office. --Clay WLIAZ Employee

Yes, if your surgeon's office can call for you that would be best. They will ask: Does this patient have the benefit for bariatric surgery related to morbid obesity? The procedure code for the band is 43770. They will then find out what the specific requirements are such as if you need diet and exercise and how many years of records (where your BMI was at least a 35) you need. Again, UHC criteria are highly standardized. --Clay WLIAZ Employee

Typically, UHC requires five years of medical records that show that your BMI has not gone below 35. PCOS certainly counts as a co-morbidity. The majority of UHC plans also require six months of diet and exercise under a physician’s supervision. I would call back or better yet have a professional call and verify the requirements with your plan. If your plan has liberal policies on authoritarian, jump on it. FYI: many of our patients with infertility often get pregnant in their first year. I thought you would find that reassuring to know that you are on the right path! I wish you well! --Clay WLIAZ Employee

You are welcome to come to our support group and see if it is something that you would like to be a part of. Our formal support group is getting rather full so we are trying to have it in other locations for our patients. Our informal groups that are patient led often have other patients that had their surgery from out of town but have joined our program for support. Good luck to you in your search. Best wishes, Clay

You are right, Tri-Care is great. I got to call all of the people that originally wanted the Band but were only covered for the gastric bypass. It was really nice to tell people the great news. It is impressive how great the coverage is. Things always change in the insurance world, but right now I think it's the best insurance you could have for the band. Congratulations! I wish you the best.

You’re right that fluoroscopy can be necessary to diagnose some complications of the band such as leaks or a port flip. Fluoroscopy is also helpful for someone learning to do lap band fills. However, it makes no sense to use fluoroscopy for routine fills. There is no need to expose the patient or the medical staff to radiation unless it’s necessary. Having ultrasound is helpful in routine fills because it’s quick and safe. If a suspected complication can’t be seen with an endoscope test or other means, then fluoroscopy is useful. Thanks for your comment.

The informal support group at WLIAZ meets on the second Sat of every month. The next one is April 12. You are welcome to come! Here is a link for future meetings: Weight loss institute of Arizona Have a wonderful day!

I would go to all of the seminars in town and find the best doctor and program for you. They are all different in what they offer for aftercare, surgery, and treatment. Everyone thinks their doctor is the best! I think that you need to spend time with the staff of each office to fully appreciate the differences. Because aftercare is essential to an effective weight loss program this should be an important part of your decision. Too often, people spend more time researching their TV than they do with their doctor. All local weight loss doctors in town offer seminars. Best of luck to you!

Having five years of medical history is essential with BCBS and most insurance companies. With any insurance company, it is black and white with coverage. With your BMI... you will have to show two medical problems associated with your weight. It looks like you have enough to do this. Your BMI can not have dropped below 35 in the past five years. If it has, the five years will start after you were back above 35. You have to have a benefit for bariatric surgery related to morbid obesity. Family history and logic have nothing to do with an insurance company’s approval of a LAP-BAND. It is unfortunate, but true. BCBS is actually a great company to work with because they don’t require a waiting period for diet and exercise supervised by a doctor.

Way to go! That day is coming up very fast. What are your plans for your next two months before the operation? Do you have any plans for anything before your date?

WLIAZ will see patients from Mexico. Many places will do fills on patients from Mexico but as far as I know we are the only ones that will see patient's that are having complications. I hope that helps. If there is anything I can do please let me know. I hope that you are doing well. --Clay

Dr DeBarros takes BCBS. Both doctors Dr Orris and Dr DeBarros will still work on your case. If there is any way you can contact me, I would be happy to speak with you about our program. How are you doing with everything? I hope that you are doing great. --Clay

At WLIAZ, Patients normally get their first fill about six weeks out. After that is based on how you feel and your weight is responding. If you are from New Mexico make sure that you tell the office this so they know that you can't reschedule. If you need any additional literature on band fills please let me know and I will make sure that you get them. I think that starting a NM support group would be a great idea. Maybe I can help with some of the planning. Thanks, Clay

I'm glad that you are doing so well now. Your progress is very impressive. Keep up the great work.