Please Give Me Advise!

[SunnyinSD 0]

I posted this in another forum and got no feedback, so I'm going to post here as well. Hopefully I'll have more luck!

I am considering gastic bypass/Lap-Band® surgery and I'm just starting to explore my options. I have BCBS of IL PPO insurance, and I'm looking for insurance to cover the surgery. I'm a 5'8" female, and I current weigh about 235. Over the past 5 years I've weighed between 252 and as low as 203.

I did a low calorie, doctor supervised weight loss diet for 6 months to lose the 50 pounds (to get down to 203), but I gained most of it back within a year or so. Because of the calorie restircted diet, I had to have my gallbladder removed about 6 months ago. I have borderline high blood pressure (and I'm only 32) and high triglycerides, but am not on any medication.

So... am I a candiate for surgery? Do I have to gain weight to be a candidate? I have been overweight pretty much my entire adult life, I have tried diet after diet and nothing sticks. I need to be around to take care of my kids and I won't be able to do that when I weigh as much as I do. Please let me know your thoughts and/or suggestions to make this surgery a reality for me.

[gingerjane 5]

I would think that the two co-morbidities would help your case. (High blood pressure and triglycerides) The best thing to do is call your insurance carrier to see if they 1) Cover the weight loss surgery because some companies do not carry that coverage and 2) see what their qualifications are. :thumbup:

Good luck to you!

Ginger

[emsbugbug 7]

All insurance companies are different. I would recommend calling them and asking if they cover it and what the limits are. Most ins. (and doctors) require a BMI of over 40 or it can be lower if there are at least 2 co-morbidities. Looks like your BMI is 35.7. I would call your insurance company and talk to your physician. I definitely would NOT recommend gaining weight to get the surgery.

[clohse 0]

I'm not sure anyone can tell you for sure if you are a candidate except the doctor, but I can tell you how I went about getting mine done using BCBS. I started by asking my regular family doctor what he thought about it. He supported it and gave me the names of a couple of surgeons in my area that give the informational seminars. I showed up at one of the seminars, filled out their "application" and turned it in. From then on, it was mostly done between the surgeon's staff and BCBS. The dr office would call and tell me what I needed to to, and I followed their directions to the letter (because BCBS can be really snarky to deal with!)

If you have any specific questions, feel free to send me a pm.

[SunnyinSD 0]

Thanks everyone! I have checked with BCBS of IL. My polocy does cover the surgery however I have to be either BMI over 40, or over 35 with 2 co-morbidities that are NOT able to be treated with the highest level of medications. I don't fall into that category. I have already attended a few seminary with surgeons in my area (San Diego) and have yet to find one that I like, but all the doctors that I have spoken with, including my PCP, think that the Lap-Band surgery is a good option for me. Now I have to just figure out how to fund the surgery. :thumbup: WHY does this part have to be SO hard?