Caught in a catch 22

[MLBL 2]

I just make the BMI requirement for the Lap Band. I really do need it, I have been living with weight issues for too long. However, the wait for the surgery is 9-12 months. If I lost even 15 lbs I might not qualify anymore. Do I intentionally not lose weight this year? That feels so fundamentally wrong. Also, I really don't want to spend another year this big. Ont he other hand if I lost some weight I know it will come back sooner or later because it always does and I will regret missing the opportunity to have the Lap Band. What to do?:confused:

[kellyjoiii 19]

MLBL,

Do you have any co morbidity issues? Such as High Blood Pressure or sleep apnea? They lower the BMI requirement from 40 to 35-39 usually. Also, have you started getting the required dr referrals and such? Is it covered by your insurance? Have you contacted a dr and this is the time frame they told you? I know some people have waited and are waiting a long time, but this is not always the case. I started my stuff in March and am having surgery the 29th of April. I did get all the pre requirements done quickly though. If this is something you are truly wanting to do, you will. Also, you can always start the referrals and approvals, and if you lose weight before your surgery well, then all the better. Good luck!

K:thumbup:

[BetsyB 9]

Are you sure that weight loss will rule you out? I'd double-check with your insurance. In my case, the ONLY weight that mattered, in terms of BMI /approval for surgery, was the weight from my very first appointment with the bariatric surgeon. I had the BMI of 40 required for surgery---but by the time all my paperwork was submitted for final approval, I was below 40.

Your policy will spell it out for you--and your surgeon's insurance specialist will be able to confirm if you have any questions about interpreting the policy.

[MLBL 2]

I have sleep apnea, two pinched nerves in my back, and had my gallbladder out two years ago. I also need a breast reduction that I cannot get because my BMI would have to be less than 30. As it is, my BMI is 37.5 If the only weight that counts for qualification is the first weight that will be great. My orientation is in two weeks so then I can ask about that. I know the weight list is that long because I am having it done at a military facility and other who have had it done there have waited that long.

[BetsyB 9]

I bet the orientation seminar will really ease your mind.

Good luck!

[adagray 1]

I felt the same way as you when I started this process. The concept of not trying to lose weight for 6+ months seemed crazy to me. I have been 'on' a diet more often than 'off' a diet for my entire adult life. In the end, though, I believe that being 'off' a diet for most of last year was quite cathartic for me.

For one thing, I decided to start exercising just for the health of it (not to lose weight). So, I learned to enjoy exercise just for the feeling of accomplishment and strength I got from it.

I also worked on other habits that would help me w/the lapband such as eating enough Protein every day, drinking enough Water, etc. You could also work on eliminating artificial sweeteners.

All of these things will help you with long-term weightloss after you get the band, but won't necessarily cause you to lose weight now (without restricting calories). In fact, I gained a lot of weight last year despite building better habits. But, now that I have the band, those habits are making a great difference.

[kellyjoiii 19]

MLBL,

As for the military facility, you know if you are a dependent and your pcm will sign off (give the referral) on it, then you can always try to find a network or non-network dr near you (I did this, as I have tricare prime and am approved for a non network surgeon) and if the sleep apnea is documented then it might not matter what your bmi is.

If you have any questions email me and I will help you if I can! :confused:

[soooconfused 0]

MLBL............if you don't mind, may I ask what MTF you are using? Im trying really hard to find out what I can about William Beaumont, and so far havent' found anything. Im wondering how long the "average" waiting time is?

[MLBL 2]

I am using Naval Medical Center Portsmouth in VA. I had heard that it was very difficult to get a network provider, but I am willing to check it out. I got a referral for the sleep apnea the same day I got the referral for the Lap Band. I have to call tomorrow and make an appointment for a sleep study.

[yorkshire 0]

Has anyone been denied by UHC and did you appeal? My claim has been submitted but I'm afraid it will be denied because my BMI has not been over 35 for 5 yrs. - only 3 yrs.

I do have several comorbidities (sleep apnea, arthritis, fibroids, back & knee pain, high blood pressure, high cholestral, hypo-thyroid, etc)

Does anyone have any suggestions to help with an appeal?:thumbup:

[yorkshire 0]

yorkshire;1447595]Has anyone been denied by UHC and did you appeal? My claim has been submitted but I'm afraid it will be denied because my BMI has not been over 35 for 5 yrs. - only 3 yrs.

I do have several comorbidities (sleep apnea, arthritis, fibroids, back & knee pain, high blood pressure, high cholestral, hypo-thyroid, etc)

Does anyone have any suggestions to help with an appeal?:thumbup:

[kellyjoiii 19]

Yorkshire,

I am not accustomed to what UHC is, however, with the co morbidity issues you have, I would think they would approve it. My surgeon would do the surgury if you showed up in his office. We are tricare (insurance) people, and if you do have the co morbidities, IF they deny you, that should be plenty to appeal :cool2: HAVE they denied you? If not, cross that bridge when you get to it! :thumbup: