question

[mperkerson 0]

If someone can get the lap band with a 40 or higher bmi or 35 bmi with comorbidities,eventually they are going to lose the weight and be under the 35 bmi scale, so my question is if they will eventually be under the normal scale to determine whether someone gets the band or not , then why can someone who is under the 35 bmi but has the health problems not get it unless they pay out of pocket? Doesn't make sense to me and seems a little bias. Just because you aren't 35 bmi doesn't mean you haven't tried to move heaven and earth to lose the weight. And reading some of the post where people are telling others to gain weight to get the band is crazy. Why not try to do everything to prevent having an unhealthy body? I don't understand, sounds totally nuts to me.

[BetsyB 9]

If I understand your question correctly, you're wondering whether someone beginning with a BMI of 35 will be ruled out for surgery if successful during the preop stage.

Check your insurance policy--it will specifically spell out the conditions you must meet. Your doctor's insurance specialist can clarify if need be.

My insurance required a BMI of 40 (with no comorbidity) or 35 (with 2 comorbidities). The weight used to determine eligibility was the first weight taken in the doctor's office.

I lost weight during the preop supervision, and was below a BMI of 40 when I went into the OR. I still was fully covered by insurance.

EVERYTHING IS DICTATED BY THE INSURANCE POLICY--it's not a matter of bias, it's a matter of what you have paid for. If you have insurance through your employer, you can always lobby for changes to the policy.

However, if you're below a BMI of 35 before seeking banding, chances are you'll wind up self-pay. You will be able to find a surgeon to do the surgery--but insurance does not generally pay unless there is a medical necessity. And that does not usually attach to lower BMI.

[Mariasha 3]

There is a thread somewhere here about people who have forced themselves to gain weight in order to be eligible for surgery.

Sad, but true.

Messed up health care system we have in this country...