MargieM

Interesting.... I called UHC twice and they stated they require a BMI of over 40 and 5 years of documented weight history. Well, I didn't have 5 years of document weight history (because I didn't have check-ups every year) - so my PCP wrote a short letter stating I had been under her care for five years and have had a BMI of 40+ - and tried other methods, ie, WW, losing weight. The Lap Band doctor's office is reviewing my info and will submit. I don't want to go thru all the tests without it being approved. So, I will keep you all posted. I think it's our job as employees to push to be approved...

I have United Healthcare (UH) for insurance. One requirement is that you have to be at least a 40 BMI before being approved for surgery. Another requirment is five years of being overweight/obese. My lapband doctor's office states I need the last five years of weight history from my doctor's office to be submitted with the Insurance approval request. I don't have five consecutive years for weight - and even if I did, it's all over the place - up and down from dieting - so I am sure it wouldn't be a BMI of 40 all the time (right now I am just barely making a 40). I called UH and asked them to go over the requirements again. The representative I talked to said a doctor's letter should work for the approval. My doctor agreed to write a letter stating my issues and trials over the last five years regarding my weight. My question is - did anyone else submit a letter from their doctor with the insurance approval request? And did you have any problem getting approved? I am worried they will try and deny the claim. I don't have the five year weight history. :confused2:

UHC said a letter should be fine - even though they state five years of history from doctor. The UHC rep didn't say I needed five years of charted weight history. But, the Weight Loss center receptionist said I did need five years of doctor documented weight history. Insurance policies vary company to company - whatever your company negotiates for the plan - so really, I don't think the receptionist can make such a general statement - but she has probably done this many times, so she may be speaking from experience.

Thanks for all the replies. This makes me feel better. My doctor is sending me the letter. I asked her to write all the diets that I have tried and state that I have been heavy for five years - which I have...even longer if they need pictures! If this doesn't work, I don't know what else will. It's not right that Insurance companies have all these demands on patients. I know insurance companies need to be careful, but if your doctor recommends that this is a good thing, Insurance companies should comply and do what is best for their patients. Again, thanks for the replies...it helps. I just hope the weight loss surgeon doctor will submit with the letter.

I feel the same way you do. I have been reading about the lapband and went to a seminar. Tomorrow, I go to my PCP and will be discussing LB surgery. I know I can drink a shake for two weeks and lose weight - AND stick to WW for a few months and lose weight. The issue is - long term I cannot keep the weight off - plus more creeps back on. This is a huge step for me too, but I am seriously considering it because I don't want to continue on this path. I need to end the yo-yo cycle. I don't have health issues, I go to the gym and do yoga. I want to be healthier and need to lose the extra pounds. Plus, I tell myself -- If I don't like the band, I will have it removed. It is worth trying as so many people on this site seem to like their band. I have heard of some issues, but again, the majority say they would do it again in a minute. Good Luck with your decision....

I went to Dr. Oh's seminar the other night - and I was not impressed. He spent the least amount of time discussing the lap band procedure. He spent more time discussing gastric bypass - which I am not interested in. Well, during the discussion he said lapbands are not good for "sweet eaters" because you can't have sugar, milk, or alcohol for the rest of your life. I asked him afterwards if that is true - because to me it doesn't seem like a way to live the rest of your life. He said this is a last resort - and no sugar because then you will have cravings for it. He also said his patients have fills every month for the first year. One question asked by someone at the seminar was regarding the amount of food eatten at each meal - the doctor responded 1-2 ounces! This just doesn't seem reasonable to me.... that's nothing. I am not sure this is the right decision for me... I was so nervous/excited about the seminar and then came home feeling this may not be the best option for me. Also, I posted the above under another thread and heard from someone on this site..the same thing about Dr. Oh. I didn't even mention his name in my post - she asked if I was from WA state...when I told her yes, she asked if it was Dr. Oh. She said Dr. Srikanth was better - but she cannot have hers done for about year either - per her insurance. I was going to look into Dr. Srikanth - but have not called yet.... I wonder what is unethical about him.... curious. Still not sure if this is what I need to do for me..but, I am checkin it out.

I went to a seminar last night on bariatric procedures. The doctor spent the least amount of time discussing the lap band procedure. He spent more time discussing gastric bypass - which I am not interested in. Well, during the discussion he said lapbands are not good for "sweet eaters" because you cant have sugar, milk, or alcohol for the rest of your life. I asked him afterwards if that is true - because to me it doesn't seem like a way to live the rest of your life. He said this is a last resort - and no sugar because then you will have cravings for it. He also said his patients have fills every month for the first year. One question asked by someone at the seminar was regarding the amount of food eatten at each meal - the doctor responded 1-2 ounces! This just doesn't seem reasonable to me.... that's nothing. I am not sure this is the right decision for me... I was so nervous/excited about the seminar and then came home feeling this may not be the best option for me. Can anyone share their experience? I may try a different lap band doctor to discuss this with. :confused2:

Interesting. All these posts and come to find out - it is the same doctor Carol in WA saw at her semiar! I am going to look into the other doctor. Thanks everyone for your replies.....I want to be thin, but it has to be a reasonable way of doing it. Having no milk and no sugar the rest of my life, isn't reasonable. Cutting back and moderation is doable!!

Carol...YES...I am in WA state...St. Francis Hospital seminar! Who did your surgery? All, thanks for all the info... makes me feel better already. I am going to my PCP in a couple of weeks to discuss. I did think the doctor may prefer to do gastric bypass because it is more profit.

I feel just like you do - and have similar height/weight. I went to the seminar last night and was not impressed. I felt the surgeon was pushing other bariatric surgeries, not lap band. He said absolutely no sugar, no milk, no caffeine. Sheeesh...why not just cut those out without getting a band. I don't think it's realistic to cut out these two foods completely!