Those of you with a lower BMI did your insurance pay?

[spoiltmom 44]

What is your BMI? DId your insurance pay for Lap Band or did you have to?

I'm just curious. My BMI is 36 but I also have high blood pressure, sleep apnea, bad knees and depression. My insurance says I qualify so I'm hoping they will pay if not at this point Dh and I may just finance it.

[Band_Groupie 3]

As long as you have a 35 BMI or above and the comorbidity(s) needed by your insurance you should be covered. You need to stay above the 35 BMI until you have your formal approval from insurance (so don't lose too much pre-op). Best wishes! -BG

[spoiltmom 44]

As long as you have a 35 BMI or above and the comorbidity(s) needed by your insurance you should be covered. You need to stay above the 35 BMI until you have your formal approval from insurance (so don't lose too much pre-op). Best wishes! -BG

So how does that work anyway? I'm going to see the bariatric coordinator to get things started on Tuesday. If my insurance requires a pre op diet how do I do it and not lose weight? What I mean is in the past I've been able to lose weight but I'm never able to keep it off. So how do I diet and not let my BMI go down?

[Band_Groupie 3]

So how does that work anyway? I'm going to see the bariatric coordinator to get things started on Tuesday. If my insurance requires a pre op diet how do I do it and not lose weight? What I mean is in the past I've been able to lose weight but I'm never able to keep it off. So how do I diet and not let my BMI go down?

I ate and drank a LOT before my first weigh in (I know, sounds counterintuitive, but I was also a long term yo-yo dieter and needed a permanent solution too...also had comorbidities like hypertension, now gone). I was told to lose about 5-10 pounds, so I just made sure I had more than that at the beginning to keep myself in the safe zone. You're expected to be a 'failure' at the diet as the 6 months is really more about your committment time and having the time to research and find out if this is for you. Don't gain (I saw one person dienied for gaining a single pound...over the entire 6 months, not by month), but don't lose much either. I won't sugar coat it, for us yo-yoers, this is a long frustrating 6 months as we know how to diet...looking back though, all the research time is what helped me be successful after the band as the plan is something new to us...NO MORE DIETING!

Let me know if I can help, and you can check out my pre-banding days here (under blogs), or at my new blogging site on Blogger (link below).

[spoiltmom 44]

Thanks! I'm so nervous about going in tomorrow and I really hope this works out. You know what my biggest fear is? That the bariatric coordinator is going to think I'm not FAT ENOUGH for Lap Band. I mean I qualify per my insurance guidelines and I'm definitely overweight by a lot but I don't look just hugely obese you know?

I'm so anxious and ready to get the first appointment over with. As a plus though the coordinator was very, very friendly and extremely reassuring on the phone.

I'll definitely check out your blog!

ETA: I'm hoping I don't have to do a 6 month pre op diet or anything but I know it's possible. My cousin had Lap Band about 4 months ago. She has the same insurance as me and she was scheduled within 3 weeks of her first consult with no problems and no preop diet requirements.

Edited May 31, 2010 by spoiltmom

[Band_Groupie 3]

ETA: I'm hoping I don't have to do a 6 month pre op diet or anything but I know it's possible. My cousin had LAP-BAND® about 4 months ago. She has the same insurance as me and she was scheduled within 3 weeks of her first consult with no problems and no preop diet requirements.

Well that's an awesome sign that you won't have to either...count your blessings! I'm hoping you come away from today with a date!!!

[spoiltmom 44]

Okay she said the fact that I'm on a C Pap machine should get me qualified automatically. In the meantime though I've been started on a supervised diet. Now if I lose too much my BMI will dip below 35 b/c it's at 36.7 right now. So how do I do the supervised diet and keep my BMI from falling too much?

Also I had a baby 2 months ago. If you look at my weight before getting pregnant my BMI was only 34. Will they look at that and disqualify me? It was 34 b/c I had lost weight- almost 45 pounds to be exact but it was all slowly creeping back on. My weight would have gone back up rather I'd gotten pregnant or not.

I can't keep my weight below 215 without constant dieting and that's still a BMI of 35.5 I think.

My last rambling is I called my insurance company to see if they require a 6 month supervised diet and the lady said my plan doesn't say it requires anything. All my plan states is that if your BMI is over 40 OR 35 and over with one comorbidity then it's a covered benefit.

Also if this does go through once I start the Pre OP diet IF I lose too much before surgery will it still be covered anyway?

[rocketray 0]

My BMI was 35 but I had a co-morbidity--high blood pressure and acid reflux. I got ok'd no problem. I did go to one doctor before who didn't even want to talk to me at all. I thought that was kind of rude, they made me sit thru an hour long presentation and then decided not to even let me talk to the doctor. So don't give up if anyone is having problems getting ok'd.

[Band_Groupie 3]

Okay she said the fact that I'm on a C Pap machine should get me qualified automatically. In the meantime though I've been started on a supervised diet. Now if I lose too much my BMI will dip below 35 b/c it's at 36.7 right now. So how do I do the supervised diet and keep my BMI from falling too much?

Also I had a baby 2 months ago. If you look at my weight before getting pregnant my BMI was only 34. Will they look at that and disqualify me? It was 34 b/c I had lost weight- almost 45 pounds to be exact but it was all slowly creeping back on. My weight would have gone back up rather I'd gotten pregnant or not.

I can't keep my weight below 215 without constant dieting and that's still a BMI of 35.5 I think.

My last rambling is I called my insurance company to see if they require a 6 month supervised diet and the lady said my plan doesn't say it requires anything. All my plan states is that if your BMI is over 40 OR 35 and over with one comorbidity then it's a covered benefit.

Also if this does go through once I start the Pre OP diet IF I lose too much before surgery will it still be covered anyway?

First of all, congrats on the new baby!!

Have your insurance company give you a copy of your bariatric policy (most can tell you how to print it online, or they can fax it to you- although you know someone with the same one, I wouldn't trust it unless I had it in writing as I've heard others get conflicting info over the phone). Take that to your surgeon's office so they know what is required of you (if they don't already- my Doc had an insurance specialist at his office that knew all the local insurance companies. Unless it says they need a 'weight history' (some require your weight history for several years back), then you past weight won't matter. Yes, sleep apnea is one of the 5 big comorbidities the ins. companies look for and if you need only one, then you've got that piece covered.

I'm not sure what the details are on the 'supervised diet' you are now on...are you scheduled for surgery, is this your pre-op diet or have they put you on some diet for a certain amount of time? Here's the deal on the threshold weights though (35 or 40), when you 'submit everything to insurance' (meaning whatever is required of you with paperwork to document it; I needed: psych, nut, cardio, and pulmonary clearance, my surgeon's approval, and a letter of medical neccessity from my PCP along with 6 monthly diet and exercise documentation forms...I think that was it) all of this had to show that I was still above the 35 BMI (meaning any weigh-in at any Dr. visit and even my last monthly diet and exercise PCP visit). After all the paperwork was submitted I waited and got my approval (the insurance company will send your surgeon an 'approval code number'), after that you can lose weight to your hearts content!

Hopefully you will only have to stay above the 35 for a few weeks...not 6 months like me! I don't think my weight had been that stable in 30 years and it was hard work for a yo yo dieter (I could also lose up to 50 lbs. at a time)...crazy insurance requirements, but I know they have to draw a line somewhere.

Back to writing the book...let me know if I can help with anything! -BG

[Jenna22 0]

I am about to post this but DO NOT BE RUDE! My BMI was 39 at my initial consultation. Because I did not have anything but reflux, my insurance assistant said that she didn't think the insurance would approve me. SHE suggested to wear LEG WEIGHTS!!! That cracked me up. I decided to just eat my life away since I wouldn't be doing that after surgery. I am a dance teacher and have a ton of leg weights so I brought on with me. I sat in the car for almost 20 mins deciding if i should do it. I had to gain 5 pounds to get to 40 BMI. So i went ahead and put on the leg weights! I walked in to take my weight......I gained the amount I needed to without the weights. Didn't need the help!

[spoiltmom 44]

I'm sort of confused and in limbo right now. My surgeon's office called last week and told me to stay on my diet b/c my insurance DOES require a 6 month supervised diet. They said they are waiting on my medical records and then they will submit it to my insurance company.

So I don't know. I'm scared right now to lose any weight at all, but I'm also very unhappy with my appearance:( I just keep telling myself to deal with it for a little longer and then I can finally start my last diet ever you know?

[Band_Groupie 3]

Yep, I know exactly how you feel...NOT losing or gaining weight is hard for dieters! I had to figure out what clothes to wear even before weigh-ins LOL. If you asked for a copy of your bariatric policy it should state '6 mo. diet' or not. You'll be able to lose the weight soon...hand in there! -BG

[spoiltmom 44]

I'm calling today to find out what the policy is. The first time I asked my insurance company I was told there is no 6 month diet needed, but my surgeon's office said they were told that I do have to do the 6 month diet so today I'm going to call my nurse case manager and see if she knows the real story.