spoiltmom

They should flat out tell you why right? Also if I am denied can I request that my insurance provide me with a copy of what was sent in for them to review? I'm waiting to see if I'm approved but I don't trust the insurance lady at my doc's office. I'm not even sure what she sent them b/c she told me she was still waiting on my medical records from my other physicians to prove my Hypertension, sleep Apnea and knee issues. I have co morbidities but they are not as SEVERE as my insurance requires so I'm sort of on the line as to rather or not they will approve me. If I weighed 20 lbs more they would approve me no questions asked. Thanks!

My BMI is 37.5 but my insurance will cover it at a BMI of 35 with one co morbidity. I have hypertension and sleep apnea so we're hoping I'll be covered with no problem.

I hope we all get approved!! The waiting is so, so stressful to me but I'm hoping and praying for approval for us all.

wow! I used to take a 1/4th of a Klonopin and it knocked me out all night. I'd be out for days with that combo. Did the tech tell you anything at the study? Normally if you have apnea the tech will tell you and they will put a Cpap or Bi Pap machine on you and complete the testing.

Well hopefully we'll all get approved! I'm hoping since my UHC doesn't have many requirements the approval process is easier and quicker. I need this so badly. good luck ladies!!!

No they won't help you they will reschedule you instead. You really need to be able to go to sleep on your own for a true result. Good Luck to you!

My friends mom was 400 pounds and she got the band. She's had it for about 2 years now and she's now at 170. She looks like a totally different person and she feels 100% better.

This is such a great encouraging post! Thanks so much!

I was worried and very emotional when I first considered Lap Band but like you it will help me regain my life and health and it's truly not the easy way out. It's not that simple. But I do think for me this is the best option. My family are supportive but my friends I haven't told yet.

I haven't been approved yet either so I could be wrong but I was told that it's fine if you have depression b/c the majority of overweight people do have depression. I have depression and my surgeon and family doc both say it's fine I should still pass the eval.

My insurance requires your BMI to be between 35-39.9 AND you must have: sleep Apnea Hypertension Heart problems Diabetes I have sleep apnea and Hypertension. The thing is they specify that your hypertension has to be UNCONTROLLED and your sleep apnea must be severe. My Hypertension is controlled with meds and my sleep apnea is moderate. So if they don't approve me at my current BMI of 37 with my comorbidities then can I just gain 20 lbs to get me at a BMI of 40? If your BMI is 40 you don't have to have any comorbidities and they will cover it no problem. I'm hoping that I'm overthinking all this and they will just approve me the first time. I so need this and I cannot afford to pay cash for it.

Thanks ladies! I'm hoping I don't get denied b/c the insurance lady at my surgeon's office said she doesn't do appeals. So I would definitely have to do the appeal myself. I'm just nervous right now!

I have moderate sleep apnea and upper airway resistance syndrome. I didn't fit the typical profile. I was dxed at age 24. I started having high blood pressure and fatigue at age 21. I was 190 lbs and I was told by my family doc that at that age there had to be a reason for my high blood pressure. He kept me on meds and did all sorts of tests. He even sent me to several specialists and then gave up and said I was healthy I just had hypertension. Then I went to work for a family doc. I kept complaining to his physician assistant about my blood pressure and how tired I was and he was like well you have sleep apnea. I said no way but he made me go for a sleep study and I tested positive. Come to find out uncontrolled sleep apnea causes high blood pressure. So yes it's possible you can have it and not know. I was told that if I get banded that my apnea should go away after I lose the weight. good luck on the sleep study!

I started out by calling my insurance company to see if it was covered. They said it was and I didn't need a referral so I made an appointment with the surgeon's office at that point. I'd call your insurance first and ask them if it's covered. Good Luck!!

I live in a small town. We only have one surgeon's office that does Lap Band but he gets GREAT review so I decided to use him. But I can't get anywhere with his insurance lady and you can tell I'm making her mad. I've called my insurance company 4 times and 4 times they have told me that a 6 month supervised diet is NOT required! Okay so I go in on Tuesday for my psych and nutrition eval so I called her to ask her when she will submit this to my insurance for approval and she said not until I've finished my 6 month diet. I then told her that I was told no diet is required and if for some reason there is they will tell us in writing when the surgeon submits the paperwork. She said that is NOT how she does things. She said the 6 month diet IS required by my insurance company and she will NOT submit anything to them until it is completed. She then told me to quit calling my insurance company and call her instead b/c she knows more about it then they do. Edited to ADD: She said she does NOT DO APPEALS and that's why she wants the diet done before submitting it. Well I feel like I'm being cheated:( If the diet isn't required then I could get this submitted and approved 5 months sooner. But instead she's going to make me wait the 5 months and finish the diet first that my insurance isn't even requiring. I don't want to make her mad b/c that is the only office in town that does Lap Band but at the same time I'm mad and I don't feel like she's listening. I used to do medical billing for a living so I'm not a complete moron and I know what to ask the insurance company and I'm getting different answers than she is. My insurance company said they would call and tell her no diet is required but I know that will tick her off b/c she thinks she knows it all. What do I do now??

Okay I called my insurance company AGAIN and my dh's HR dept and what it all boiled down to was THE FREAKING LADY NEVER CALLED THEM!! That's right the insurance company pulled up all my notes and said that the only time she called them was today and she's never called them before that. So the lady called me back 20 minutes ago and said OK I talked with your insurance and they don't require the diet after all so I'm submitting this and hopefully you'll be approved by next week. I'm so aggravated with her. I knew she couldn't have called them b/c they wouldn't tell me one thing and tell her something else. Now I just HOPE they approve me. She said if they approve me right away then I can be banded by mid August at the latest. Cross your fingers for me guys!

Congratulations!! What insurance do you have?

So give me some ideas of life after banding. What do you typically eat every day?

with all these appointments. So far my mom and DH are the only ones who know I'm trying to get Lap Band. My problem is though I don't really want to tell my MIL yet but my dh works all the time so my MIL is the only person I have that can babysit while I go to my appointments. My kids are 9,3 and 3 months. It may be fine for them to go to my monthly weigh ins at my family doc but I can't see taking them to my nutritionist, pscyh or surgeon appointments. I've never lied to MIL and she truly is the only person I have that can baby sit and I don't want to take advantage of that. So should I just sit her down and tell her what's going on and tell her it's a secret or what? What would you do?

I think my MIL will be supportive but FIL will be very discouraging and I'm closer to my FIL than to my real dad. I have to tell her though b/c I was out today at the family doc and I'll be gone most of the day Tuesday for my Psych and Nutrition eval.

My insurance covers it BUT there are no psychologists or counselors here that take my insurance SO If I use a counselor its $150. It's $350 to use the psychologist. My insurance will reimburse me but only at like 70%.

I go next Tuesday for my psych eval and my nutrition consult. I'm on a 6 month supervised diet b/c my surgeon's office said my insurance required it. I go for my second weigh in tomorrow. But I've been on and off the phone all day long with my insurance company- United Healthcare and every person I spoke with said the diet is not required at all so I'm hoping that means I can get approved sooner!! Meanwhile I go to the family doc for my weigh in tomorrow. I've never had my cholesterol levels checked. Would it hurt to have that done also? I already have Hypothyroidism, sleep Apnea, Hypertension, GERD and arthritis in my knees but my insurance company said that they consider hyperlipidemia as a comorbidity also. I'm trying to EVERYTHING I can to get this covered! And BTW, how many of you had to pay cash for the nutrition and psych exam? My insurance covers the surgery 100% but not the nutrition or psych visit. I'm not complaining though at least the surgery is covered.

My cousin was banded a few months ago and she was able to eat normally before surgery so I'm wondering what is the purpose of the pre op diet? I see most people are doing a liquid/soft diet pre op. Why is that?

I mean may be wrong but once your insurance approves you I don't think they can go back and deny you however, the problem may be that the surgery has to be postponed if your liver is too big.

My surgeon notified me within 2 days. I'd call and check on it if I were you.