SexyUnderneath 1 Posted August 8, 2011 Hi there! New to the boards and just starting my lap band journey. I am gathering as much information as possible. I am 99.9% sure this is what I want to do. I think my biggest obstacle right now is getting Kaiser to cover my procedure. I am 36 yr old, 5'4" and 234 lbs. I have a BMI of 40 and was diagnosed with PCOS a year ago and have been taking Metformin and unable to lose weight. So frustrating!!! Anyway, just wanted to say hello, and I look forwarding to getting know all of you Share this post Link to post Share on other sites
MelindaH 3 Posted August 9, 2011 Hi there! New to the boards and just starting my lap band journey. I am gathering as much information as possible. I am 99.9% sure this is what I want to do. I think my biggest obstacle right now is getting Kaiser to cover my procedure. I am 36 yr old, 5'4" and 234 lbs. I have a BMI of 40 and was diagnosed with PCOS a year ago and have been taking Metformin and unable to lose weight. So frustrating!!! Anyway, just wanted to say hello, and I look forwarding to getting know all of you I don't want to discourage you from the band, but I have heard that Kaiser won't pay for it--only the RNY. You may already know this. Just check it out thoroughly. all the best to you. You will find that the folks who post here are very knowledgeable and supportive. Drop in often. Melinda Share this post Link to post Share on other sites
Snoopyloverny 3 Posted August 9, 2011 I am 5'1 & 230 lbs, nice to meet u- also ready for LB process! Research research research !!!!' Share this post Link to post Share on other sites
SexyUnderneath 1 Posted August 9, 2011 Hi Ladies! Thank you for the welcome! Yes, I have heard that Kaiser won't cover it, or it is a miracle if they do. I will explore my options with them and if I get no where I will just pay cash. It would be nice to actually have your insurance company do something for you, but in the end I will do what it takes to have this surgery! I have been lurking here for a few months, and yes everyone here is very knowledgeable and I can't wait to learn as much as I can Share this post Link to post Share on other sites
jst81 2 Posted August 10, 2011 Hi, I too have Kaiser in Nor CAL, just depends on coverage provided, I have checked 3 times now and lap band for me is coverd consider outpatient surgery as Gastic is considered hospital stay which is double of outpatient costs Share this post Link to post Share on other sites
SexyUnderneath 1 Posted August 10, 2011 Hi, I too have Kaiser in Nor CAL, just depends on coverage provided, I have checked 3 times now and lap band for me is coverd consider outpatient surgery as Gastic is considered hospital stay which is double of outpatient costs Thank you! That is great to know! I am praying that this works out for me!! Where are you in the process?? Share this post Link to post Share on other sites
MeFirstFinally 2 Posted August 10, 2011 Hello, Congratulations on the beginning of your journey. I have Kaiser Permanente in Ohio and was told by their bariatric coordinator that they would cover RNY, sleeve and band. I have the PCP visit on August 24, so I will learn more then. I am 5 ft tall with a BMI of 37.1, but I also have three of their 4 hot button co-morbidities, diabetes, high cholesterol and high blood pressure. I probably have number 4, sleep apnea, as well but have never been tested. She seemed pretty confident that it was a slam dunk. PCOS is a pre-diabetic condition and you are already on a diabetic medication. Have you been tested for apnea? With you BMI I don't know why they wouldn't cover it. Except that prevention is just not the way our health care/insurance system works. I wish you the best of luck. I be cheering for you. Robbie :party: Share this post Link to post Share on other sites
jst81 2 Posted August 10, 2011 Thank you! That is great to know! I am praying that this works out for me!! Where are you in the process?? I just begun myself last week,, I have my inital class/consultation 9/2, my regular dr gave me a "heads up" to start early losing the weight so I'm shooting for 15-20lbs off by 9/2, He put me on 1200/day calorie diet and work out 50min a day routine biking and swimming , was told Surgeon asks for 10% weight lose, for me that 42 lbs, So far not really hungry, and have a slight bit more energy, sure the cravings will it soon, just have to get through it, luckily my wife is also trying to lose weight, not through surgery but we are watching what we eat and no more junk food, sodas, juices. Best of luck to you Share this post Link to post Share on other sites
SexyUnderneath 1 Posted August 10, 2011 Hello, Congratulations on the beginning of your journey. I have Kaiser Permanente in Ohio and was told by their bariatric coordinator that they would cover RNY, sleeve and band. I have the PCP visit on August 24, so I will learn more then. I am 5 ft tall with a BMI of 37.1, but I also have three of their 4 hot button co-morbidities, diabetes, high cholesterol and high blood pressure. I probably have number 4, sleep apnea, as well but have never been tested. She seemed pretty confident that it was a slam dunk. PCOS is a pre-diabetic condition and you are already on a diabetic medication. Have you been tested for apnea? With you BMI I don't know why they wouldn't cover it. Except that prevention is just not the way our health care/insurance system works. I wish you the best of luck. I be cheering for you. Robbie :party: Robbie thank you so much! I have not been tested for apnea, maybe I will look into that! My husband tells me I do snore a lot and I often wake up tired like I haven't had enough sleep even after 9+ hours in bed. I know what you mean, prevention is the key! I don't have my appt with my PCP until 9/9, wish is was sooner, I am so ready to get this journey started! Keep me updated on your progress with Kaiser! Good luck!!!! 1 Bree Price reacted to this Share this post Link to post Share on other sites
SexyUnderneath 1 Posted August 10, 2011 I just begun myself last week,, I have my inital class/consultation 9/2, my regular dr gave me a "heads up" to start early losing the weight so I'm shooting for 15-20lbs off by 9/2, He put me on 1200/day calorie diet and work out 50min a day routine biking and swimming , was told Surgeon asks for 10% weight lose, for me that 42 lbs, So far not really hungry, and have a slight bit more energy, sure the cravings will it soon, just have to get through it, luckily my wife is also trying to lose weight, not through surgery but we are watching what we eat and no more junk food, sodas, juices. Best of luck to you I have too heard that they like you to lose weight prior to surgery. I recently re-joined weight watchers hoping for some loss and to be able to prove to them that I am trying. I have done WW before, it is a great program. I just need the weight to stay off after I lose it . Good luck! Keep me updated on your experience with Kaiser! I am rooting for you!!! Share this post Link to post Share on other sites
connie3 43 Posted May 31, 2012 Hi, I was just wondering how the Kaiser thing was going for you? I'm also lookin into getting the surgery and I also have Kaiser. Share this post Link to post Share on other sites
mmv671 25 Posted May 31, 2012 I had my surgery done through kaiser in 2010. The issue you will have is that you only have 1 co morbidity. You need two with a BMI of 40. I have diabetes and I had high blood pressure.y BMI was 35. You can have NAND RnY or the band and I think they are covering sleeve now as well. Share this post Link to post Share on other sites
SexyUnderneath 1 Posted May 31, 2012 Hi, I was just wondering how the Kaiser thing was going for you? I'm also lookin into getting the surgery and I also have Kaiser. Hi!! The Kaiser process has been looooonnngggg! They will cover gastric bypass, the sleeve and the band. I have a BMI of 39 and only one co-morbitiy. I really think it depends on each persons situation. After all the classes, psych eval, and bariatrician appointment I have decided on the sleeve. I just feel it is the best fit for "me". Good luck with your journey, be patient and know it will take you about a year to get through everything. Share this post Link to post Share on other sites
connie3 43 Posted May 31, 2012 Where do you have Kaiser? I have it in Southern Cali. My BMI is 40 something, but I don't have comorbidity. Can I still qualify? Share this post Link to post Share on other sites
SexyUnderneath 1 Posted May 31, 2012 Where do you have Kaiser? I have it in Southern Cali. My BMI is 40 something, but I don't have comorbidity. Can I still qualify? Hi! Yes I am still with Kaiser. I think if your BMI is 40 you don't have to have any comorbities. I have PCOS, and insulin resistance. So not really "red flag" co morbities. I am going through the Fontana facility. Which one are you looking into?? Share this post Link to post Share on other sites