SeamsSew

My insurance company, BC/BS of Illinois, requires, among many other things, that you go on a physician-supervised weight loss diet for 12 months prior to surgery. My question is, has anyone done this? I've been told that BC has very specific requirements regarding the diet. What happens if you don't lose weight? What happens if you lose a lot? Any experience out there?

My plan requires a 12 month physician-supervised diet, so I don't think an LA Weight Loss diet would qualify in my case. The insurance company sent me a letter outlining everything necessary to qualify for the surgery, including the 12-month diet. You also have to have a BMI >40 for 5 years or a BMI >35 with two co-morbid conditions for five years. Yup, they just want you to give up and go away. I just need to decide if I want to do this, then plan my strategy for fighting them. However, when I attended a local physician's seminar, the insurance expert there said "I'm very sorry to hear that." when I said I had BC/BS of Illinois. Apparently they're difficult to deal with. I really appreciate all the advice I've received here. You guys have been great.

Dani-- I'm so sorry to hear about your bad luck. I agree, the forced diet is rediculous. It's as if they think you've never seriously tried to lose weight before and just up and decided one day to have lap band surgery rather than diet. People opt for the band because they *haven't* been able to successfully lose and keep off weight.

Emily: Thanks so much for the valuable information on getting insurance coverage. I'll keep her name and number and give her a call when I get back to the lap band issue. I've spent the summer dealing with several non-life-threatening health issues so I haven't had much time to think about being banded. Hopefully, things will get resolved shortly and I can get back to deciding about being banded.

I also have the problem that my BMI is 38.4 or something like that. I have two co-morbid conditions, but my insurance company requires that you have a BMI >35 and the two co-morbid conditions for 5 years. I meet all the criteria except I've only had the second co-morbid condition of several months (diabetes.) I'll probably wind up having to go self-pay if I decide to do it.

Thanks, Wheetsin.

I mean what do the initials PB stand for?

That's not what I wanted to hear.

What does PB stand for?

I take a sustained release medication and you can't crush those because it destroys the sustained release ability. The pill is larger than a tic tac, so what does a person do? (I haven't been banded yet, just researching.) BTW, this site is really helpful! You folks are really helping me get my questions answered.

Judi-- I'm sorry to hear about your problem. It sounds awful. Unfortunately, I have no advice to offer, since I'm only considering the surgery. However, your post brings up a question I have regarding a term I keep seeing. What is PBing?

I have the same problem--my BMI is below 40. However, it is over 35 and I have two comorbidities, as my insurance requires. However, my carrier requires that you have a BMI above 40, or at least 35 with two comorbidities for 5 years. I have had only 1 co-morbidity for 5 years. I thought about gaining weight for about 5 seconds before I dropped the idea. So, it looks like I'll be self-pay, if I proceed. After a career in human resources administering health care benefits, I can second the comment that health care fraud is nothing to fool around with. It's considered a crime. (Yikes!)

Hello everyone. I've been lurking for awhile and have decided to come out of the shadows and ask some questions. I'm considering banding, but am doing considerable research before I make he jump. I've visited some local forums as well as this one and am concerned about the number of problems people have seem to have after being banded. I see people talking about being hungry all the time, vomiting, not being able to eat a variety of foods, losing their hair, needing more surgeries, etc. Am I reading these things because people who are having problems tend to be the ones who post, or do most people encounter multiple problems after being banded?

Thanks for your responses. They're reassuring.

Sounds like you've yet to join the club, too. I wish you well on the 31st. I'm scheduled to attend a local seminar in a week or so. Maybe I'll get some of my questions answered. I've attended one seminar, but decided against that physician. I hope this proves to be a better experience. Thanks for the good information.