Need A Little Advice

[onemoretry1 0]

Hi All,

I am seriously thinking about getting the lap band. I don't have the proper insurance right now, but I will be changing insurance at open enrollment. I am attending a seminar next week. My BMI is currently 43 and I am at my heaviest 250lbs. Here is where I would like to ask for your opinions. Since open enrollment is not until November I would like to get some of this weight off of me.

I was thinking I would lose about 50lbs, I have been losing and gaining these same 50lbs for the last 15 years. I know I can do it, my real problem is keeping it off. Now if I do that it will change my BMI to34. I have acid reflux, depression , lower back pain and knee problems. I can provide a 5 year weight history. Do you all think I would still qualify or should I just stay where I am? I did talk to an lap band advocate and she said we could go ahead and start the 6 month diet plan now, so I will be talking to her more about it, but still wanted to ask what you guys thought. Thanks in advance for any help you all can give.

[onemoretry1 0]

52 views and no reply, I would think at least one of you has an opinion. I'll just wait and talk to the advocate. Thanks anyway...

[CheckYes 46]

52 views and no reply, I would think at least one of you has an opinion. I'll just wait and talk to the advocate. Thanks anyway...

Hey, I just saw this. Sorry you didn't get any other replies.

I don't know what your new insurance will require but if you lose 50 pounds, you may see that the comorbidities you listed have improved. Your back pain may go and the knee pain may lessen too. The acid reflux and depression may improve as well. It will all depend on what the new insurance requires. If your BMI is only 34 - you may not qualify. Without knowing the requirements, I don't think anyone can say whether you will or will not qualify. As far as I know (and I was self-pay), each insurance carrier is different.

If you can lose 50 pounds without the lapband then maybe you can lose all your excess without one? Has the advocate given you an any as to what the actual requirements for the insurance are other than a six-month diet plan?

I wish you lots of luck. I say get started now and see where you end up. Best wishes!

[tntmom 1]

I think the FDA just changed the requirements to 30 bmi with comorbidities. Good luck!

[onemoretry1 0]

Hey, I just saw this. Sorry you didn't get any other replies.

I don't know what your new insurance will require but if you lose 50 pounds, you may see that the comorbidities you listed have improved. Your back pain may go and the knee pain may lessen too. The acid reflux and depression may improve as well. It will all depend on what the new insurance requires. If your BMI is only 34 - you may not qualify. Without knowing the requirements, I don't think anyone can say whether you will or will not qualify. As far as I know (and I was self-pay), each insurance carrier is different.

If you can lose 50 pounds without the lapband then maybe you can lose all your excess without one? Has the advocate given you an any as to what the actual requirements for the insurance are other than a six-month diet plan?

I wish you lots of luck. I say get started now and see where you end up. Best wishes!

Thanks so much for your reply, I have been able to get 50lbs off in the past, but never all of it and I always, always gain it back. I wish I could get to goal without help. The advocate will be at the seminar on Thursday so I am going to gather as much information from her as I can.

I think the FDA just changed the requirements to 30 bmi with comorbidities. Good luck!

Thanks for that information it really helps.

[stateofzen 46]

I did my 6-month supervised diet under one insurance and then switched to a different insurance because my employer had specifically decided not to cover the surgery. I was approved right away on the new insurance (didn't have to redo the diet)-- it's like the one thing that they actually require that you have a documented pre-existing condition

I was still above a 40 BMI though. I'd want to get assurance from my surgeon or program coordinator that they have experience getting people approved based on starting weight at consultation/start of 6-months, even if the you drop under a 35 BMI by the end of that period.

Still, there is always the risk that they won't approve it. I don't think anyone can tell you for sure until it happens.

[onemoretry1 0]

I did my 6-month supervised diet under one insurance and then switched to a different insurance because my employer had specifically decided not to cover the surgery. I was approved right away on the new insurance (didn't have to redo the diet)-- it's like the one thing that they actually require that you have a documented pre-existing condition

I was still above a 40 BMI though. I'd want to get assurance from my surgeon or program coordinator that they have experience getting people approved based on starting weight at consultation/start of 6-months, even if the you drop under a 35 BMI by the end of that period.

Still, there is always the risk that they won't approve it. I don't think anyone can tell you for sure until it happens.

Thanks for your reply. maybe I should just get my BMI down to 40 and try to hang out there until the end of the year. I just don't want to gain anymore weight waiting for open my new insurance.

[vickyd 24]

Is there any way you can find out what the requirements are to have your surgery covered by this new insurance. You need to find out the BMI requirement and whether or not you will have to do a medically supervised diet before surgery. Knowing those things will help you make an informed decision.

[Rachael 4]

Hi All,

I am seriously thinking about getting the lap band. I don't have the proper insurance right now, but I will be changing insurance at open enrollment. I am attending a seminar next week. My BMI is currently 43 and I am at my heaviest 250lbs. Here is where I would like to ask for your opinions. Since open enrollment is not until November I would like to get some of this weight off of me.

I was thinking I would lose about 50lbs, I have been losing and gaining these same 50lbs for the last 15 years. I know I can do it, my real problem is keeping it off. Now if I do that it will change my BMI to34. I have acid reflux, depression , lower back pain and knee problems. I can provide a 5 year weight history. Do you all think I would still qualify or should I just stay where I am? I did talk to an lap band advocate and she said we could go ahead and start the 6 month diet plan now, so I will be talking to her more about it, but still wanted to ask what you guys thought. Thanks in advance for any help you all can give.

I would be careful about losing all the weight. I would say go for 25-35 lbs lost. That way, you would (hopefully) be approved for surgery. I did the same thing with losing and gaining. I was careful on my pre-op diet not to lose too much. I know that sounds awful but I knew I needed help to maintain the lost.

Good luck!! I hope it works out for you!!

Rachael

[onemoretry1 0]

Is there any way you can find out what the requirements are to have your surgery covered by this new insurance. You need to find out the BMI requirement and whether or not you will have to do a medically supervised diet before surgery. Knowing those things will help you make an informed decision.

Thanks for the reply Vickyd, yes, I can and I will. I have a friend at work that just had the surgery so I can get all I need from her or just call the insurance company myself.

I would be careful about losing all the weight. I would say go for 25-35 lbs lost. That way, you would (hopefully) be approved for surgery. I did the same thing with losing and gaining. I was careful on my pre-op diet not to lose too much. I know that sounds awful but I knew I needed help to maintain the lost.

Good luck!! I hope it works out for you!!

Rachael

Rachel, thanks for your reply. I really want and need this surgery, I am 112lbs over weight. I really can't chances them turning me down, I will take your advice and lose very little.