Looking for input from LB'ers who went through the insurance approval process. What can I expect?

[momo3bur 0]

Hi! My name is Ashley. I am just now considering having the lap band surgery done, and with my very small amount of research, I've got different answers to my questions. So I found this site and figured it would be a good starting point to gain a forward point of view.

A little backgound info:

I am 26 years old, 3 kiddos, married, and I have been overweight and steadily gaining (when not dieting and sometimes when dieting) for about four years. Before then, I remained around 125-135, was very active, ran three miles a day at least, weight training 3x week, rode my horses, and I was able to eat like an elephant without gaining any weight. Well, I got prego with my first daughter and gained around 40 pounds, which the doc said was "ok" ish since I was fairly small when I got pregnant. I lost all of the weight after I had her within about 5 months, but it was a struggle and I've struggled constantly since. I managed to slowly pack on about 20 pounds by the time she was 2 and then all of the sudden about 40 more before she turned three. I then got pregnant with my son then almost immediately with my daughter, who are one year and five days apart, so I was basically prego or in postpardum for two years. I have lost 25 pounds, here, gained it back, 15 there, gained it back plus 5 more, etc., etc., etc. You all know what I'm talking about. Anyway, after bombing with WW, Nutrisystem, phentermine, Sparkpeople, and pretty much everything I could come up with, I've decided to look into this surgery, get it over with before I'm 30, and beable to enjoy my youth as a thin person. I even went out and bought horses again hoping that I would be motivated to be more physically active doing something I LOVE, but I simply found that I can't get in my saddle without using a chair to help me mount so I don't cause the horse any chiro issues and that I am incredibly unbalanced from being top heavy, not to mention how akward it feels having all that blubber bounce around on top of my poor horse. I always wonder if she thinks she's being punished for something when I ride her. And I usually feel like my knees are going to collapse inward after a long ride. LOL!

My entire family is VERY overweight, and I am so afraid that I will end up dead at 60 from a heart attack or diabetes like my grandmother. SOOOO, I guess, to get to the point, my questions are:

1. What have the requirements for most insurance companies been in the past weightwise, Healthwise, etc.?

2. How long is the process during which you are being considered and accepted for the surgery?

3. Since I've already wasted so much time and money on trying different weight loss programs, will I have to repeat these to please my insurance company or will they accept my previous trials?

4. How hard was it to care for small children afterward?

5. Do you think I will qualify?

My height is 5'3" and weight 222. I've had conflicting answers when asking this question. According to this site, my weight is close to morbidly obese and I should qualify. But I'm not sure if different insurance companies have different qualifying factors or weights than this site.

Thank you everyone who reads this and please, please share your experiences with me. I am trying not to be impulsive about this decision, so I would like to gather as many experiences, opinions, and facts as possible before I really commit. I have an appointment to talk to my family doc about this in about a week and a half, so I 'm hoping this will give me plenty of time to research and talk to people who have gone through this.

[Mariasha 3]

Most insurance companies require you to have a BMI of 40 or of 35 with two co morbidities.

Some have additional requirements also.

What insurance do you have?

[momo3bur 0]

I have CBA insurance. I also have high cholesterol. I guess I could call my insurance company and ask them what the requirements are, huh?

[Mariasha 3]

Would be a good start. Where do you live?

[momo3bur 0]

I live in East Texas. I don't think my doctor is opposed to trying this, which is a good thing, I suppose.

[happygirl65 5]

Definitely bring it up with your doc. Maybe they will help with the letter of recommendation for the insurance company and maybe they wont...mine wouldn't...had to get someone else...I am still in the process of approvals.

As the prev poster stated most ins companies require 40 BMI or 35 with co-morbidities

You can also expect to:

1. List diet history including dates, how long you tried it, how much you lost etc

2. Some require 6 months supervised weight loss that is documented by a doctor with monthly weigh ins (not all)

3. Recommendation letter from your primary doc

4. Proof of morbid obesity for 5 years (mine wants that...all may not but it has to be in the form of chart notes from doctor visits)

5. Attendance of phsych evaluation, nutrition education, seminar and documented plans for support afterwards

The very best thing you can do is call your ins co and ask. They should send you everything you need to know including how much your cost sharing/access fees are.

Good luck to you.!