Christine_California

I have Anthem Blue Cross, specifically. I was denied because I haven't had a 6-month physician supervised weight loss effort and determination of my compliance with it. I have been on several vaguely physician supervised (Phen-Fen long ago, NutriSystem, Weight Watchers, etc.) diets. Has anyone gotten around the requirement of having to go through a physician-supervised 6-month program before being considered for the band? I have plenty of medical complications from my weight so I'm surprised I was denied.

I'm curious of those of you who have had the band a long time and have been at your goal weight for a long time. How many calories do you eat per day to keep the weight off? I've been keeping a food diary and calorie count for a couple of months. I haven't been restricting myself much, just trying to be more aware of why I'm eating, when I'm full, etc. I used an online calculator to see how many calories per day my body should need if I were interested in maintaining my high weight, not counting calories burned via physical activity. It said I "need" about 2600 calories per day, and through my food diary, I average 1600-2100. I suppose through all those years of dieting, my body has gotten pretty good at hanging on to any calories. I don't want to be one of those people who seem to be kidding themselves and say "I don't really eat that much! Why am I fat?" but I can't figure out another explanation...

Thanks for taking the time to respond. I guess my problem for now is that my family doctor takes care of all my weight-related complications and since she isn't a supporter of WLS, I don't really have anyone on my side at this point. Maybe I'll contact the pulmonologist who prescribed the CPAP for apnea, and my former psychiatrist is well aware of how much my weight impacts my life, so she'd probably be supportive and write a letter as well. Its very easy to give up and just say I've done this to myself, its just a matter of controlling what I put in my mouth, blah blah blah, so why should I expect health professionals and insurance companies to support me? :cursing:

I don't fully understand my "denial" paperwork, but it looks like my physician didn't properly document my BMI, my weight and my co-morbidities. I saw my primary care doctor and she said she put through a request for referral to the bariatric surgeon. I got a letter today on letterhead from my physician's medical group, saying I was denied because they didn't have info on my BMI, my height and weight, my co-morbidities, my psychological fitness for surgery, and documentation that I've been on physician supervised diets. So essentially none of the health history we spent an hour discussing was passed on. But in the letter I was given instructions on how to file a grievance, and the grievance letter is to be directed to my insurance company. So I'm not really sure who denied me. At this point I'll write the grievance letter pointing out all the ways I am appropriate for WLS, and if it turns out it was actually the doctor who wasn't cooperating, I'll switch doctors. I have two coworkers who were referred to WLS through another primary care physician.

So I had to go to my primary medical doctor to get a referral to the lapband surgeon for insurance purposes, as I'm sure many of you did as well. She is clearly not a fan of WLS. She said "you have a long road" before she feels I'd be appropriate for WLS. She would "rather I do it through diet and exercise", yeah, me too, Lady! She wants me to keep a record of my blood sugars and a food/exercise diary for another month and THEN "come back to see her" to discuss it further. She referred me to another nutritionist. She referred me to a weight loss support group. I told her I've attended two weight loss support groups for a total of three years. I've done all the usual diets (WW, Jenny Craig, South Beach, Phen-Fen, fat camp) and exercise over the course of 20 years. I'm currently in a catch-22 situation because my body hurts too much to do exercise other than swimming, and swimming doesn't produce weight loss according to my doctor (or at least it doesn't for me, swimming laps 30 mins to an hour 4-5x per week for years). I'm diabetic, have high blood pressure, slightly high cholesterol, sleep apnea, joint problems. I'm also relatively young and "healthy" otherwise - I'm practically the poster child for a good candidate for a lapband. It was VERY frustrating to sit there across from my underweight doctor and have her sort of poo-poo the whole thing. I'm tempted to say screw you, I'll self pay, then. But with all the money I pay to my health insurance company, I'd really like them to help me out financially with this one. Its in the best financial interest of my insurance company in the longterm too! ARGH.

Thank you!

I'm in Santa Cruz.

Hi all, I wonder what answers would cause me to be denied the band? My surgeon's program seems really excellent. As part of the first appointment there is a questionnaire to bring along. I'm not really a classic binge eater, but most evenings I do eat too much at dinner and am beyond full. One of the questions is "I eat until severely overfull" or something like that - if I say yes, will I then be told Oh you're a binge eater, you'll screw up your band and shouldn't have it. Another question is "what are you most afraid of in regards to the band?" - I feel like my answer should be postoperative pain or something like that. My real fear is not finding a healthy replacement for my emotional eating. I'm also afraid I'll "fail" the psych eval for similar reasons. Has anyone faced this and what do you suggest?

Hi, I've been researching WLS for years, kept deciding I could do it with diet and exercise, but am finally ready for the band. I'm in California, 42, in the medical field, a single mom to two young women. I would hope to lose about 100 pounds (the surgeon says band patients usually don't end up "thin", but 100 pounds would make a huge difference in my life) and it looks like I may be able to get the procedure done by January.

My coworker who had gastric bypass said she would be able to get insurance to cover her abdominoplasty/panniculectomy because the excess skin was causing rashes and back pain and thus it was deemed medically necessary. She is working in another area of the hospital now so I haven't been able to talk to her to see if it actually was approved. Anyone else had this? I have Blue Cross PPO. How much does an abdominoplasty generally cost?

Hello all, I assume the purpose of the preop liver diet is to shrink the liver so getting the band around the stomach is easier? Years ago I had an ultrasound and it showed I have a fatty liver as I imagine many of us obese folks do. Did anyone know ahead of time that they had a fatty liver? It sounds like different surgeons prescribe different diets - "real" food vs. shakes. Is the aim of the liver diet high Protein, low fat? Anyone else have Blue Cross PPO in California? Curious how the approvals have gone. I have plenty of co-morbidities. The surgeon that I'm considering asks that people go into their family practice physician first. Did most of you do this? What does the psych eval entail? What are they trying to determine? A couple of people who had gastric bypass (which I won't do) said one plus is that since their stomach was cut away, many of the hunger pain hormones/receptors are gone too. Even though the lap band squeezes the upper part of the stomach to give a feeling of fullness, is the lower portion of the stomach going crazy with hunger pains? Thanks!

I've been reading up on Lap Band for couple of years and I think I'm ready to use it as a tool to force me to stay on track. I'm only at the stage where I'm going to a local doctor's informational meeting in a couple of weeks. I don't know if I'll necessarily choose him as my surgeon. I'm in Santa Cruz, California. I have dozens of questions! Two acquaintances had the standard gastric bypass and all of that cutting of our normal anatomy just seems wrong to me. Additionally, I have irritable bowel syndrome and I would fear that bypassing part of the intestine would make my problems worse. I'm looking forward to learn from your experiences!