Bcbs Of Ma & Beth Israel Deaconess Med Ctr.

[klawson617 2]

I'm in the very early stages of considering lap band and I'm doing my research to prepare myself for what's to come. During my most recent visit with my PCP, I asker her if she thought I'd be a good candidate for it. She said that I'm a good fit given my well documented battle with my weight (she's been my PCP for close to 10 years). With that, I went ahead and attended an information session at Beth Israel Deaconess in Boston just this past Thursday. I was advised by one of the coordinators to give the hospital's Weight Loss Surgery Center a call to schedule an initial assessment and education with the center's nurse. Excited, I gave them a ring first thing the next day. Right out of the gate, I've encountered my very first obstacle.

Basically the center won't even bother scheduling an appointment with me because my BMI is 39.1 and I have no co-morbidities. The program coordinator said that they won't be able to get approval from my insurance carrier, BCBS of MA. I was really surprised that they pretty much wrote me off so easily and quickly without even reviewing my medical records. Though I'm not a diabetic and don't have sleep apnea (not that I know of, at least)--the only 2 co-morbidities that BCBS of MA really care about, here's a run down of my health issues that I strongly believe warrant the center's and my insurance's consideration:

• I'm on cholesterol-lowering med
  
• I'm on BP med
  
• i've been prescribed metformin
  
• I'm currently taking phentermine
  
• I've been overweight for over 6 years
  
• I've made wholehearted attempts to lose weight and am able to provide documentation (atkins, weight watchers, south beach, gym receipts, trainer receipts, body media)
  
• Diabetes runs on my mother's side of the family (my mom is 125 lbs and being monitored by her PCP because of high glucose level, despite healthy diet and active lifestyle, basically she's pre-diabetic)
  
• I have 2 uncles who died at 32 and 44 respectively due to stroke
  
• My father passed away at 49 of coronary atherosclerosis
  
• My paternal grandfather suffered 2 heart attacks before the age of 60
  

So you see, I'm in a bit of a conundrum here. I'm unhealthy, but not unhealthy enough by my insurance's standards. I have very high risk factors but not high enough for my insurance to finance the procedure. Really, if I were to gain 5-6 lbs, I would qualify for the surgery but that would put my BMI only at 40.1...right at the very cusp, which still won't guarantee insurance approval because of varying formulas used to calculate a person's BMI. Also, I feel like gaining lbs to qualify would only start me off on the wrong foot if I'm to take this whole process seriously. I've heard of people finagling their weigh in by wearing extra heavy articles of clothing at their appointments, ankle weights, stuffing their pockets rolls of quarters, or gorging themselves silly minutes before they step on the scale. Don't get me wrong, I'd be a hypocrite not to admit that I haven't thought about doing the aforementioned things to "pad" my weight a little. Besides, we're only talking about a few lbs here, not 10 or 20. However, I'm also scared of getting caught. What if they ask me to put a hospital gown on? I would be totally busted....unless of course, there's someone in this forum who can attest to the fact that BIDMC won't poke and prod you during your initial assessment.

My other choice would be to go through another hospital's program that would be more supportive and would take the time to go through my records and help me with obtaining my insurance's approval. If anyone here has any suggestions of other clinics and/or MDs I should consider in the Boston and surrounding areas, please reach out to me.

My PCP is signing me up for a sleep study to check for sleep apnea, something that would be required either way for precautionary reasons. Here's to hoping (no matter how awful it sounds), that the results come back positive for sleep apnea. I already feel awful just wishing for such a horrible thing.

I'm not exaclty sure of what steps to take next therefore any feedback would be much appreciated!

[cakelly73 28]

I have BCBS of NJ, and i thought high blood pressure was a co-morbidity? I had no co-morbidities, but my BMI was well over 40, and i was approved in 2 weeks. Your surgeon 's office should be able to appeal/fight with BCBS to get you approved, being a medical biller for 12 years i know it can be done. Dont give up, and ask them to fight on your behalf.

[klawson617 2]

I have BCBS of NJ, and i thought high blood pressure was a co-morbidity?

If I'm not mistaken, persistent high blood pressure despite meds, makes it a co-morbidity. My blood pressure is just borderline high, with my meds. This is really frustrating and discouraging, especially since I'm in the very early stages of the whole process. If this is a preview of what's to come, I imagine the rest will be an uphill battle.

[Letsdothis 2]

It will definitely be a uphill battle, but if u r serious about it you can definitely defeat it. I've started this process in January 44 bmi with no health issues. My paper work was submitted it was denied the first time cause hospital put down inpatient, so resubmiited for out patient. And now pending for 2 weeks. So u see is just a game that we all to play...good luck to u.

[Sue Magoo 71]

Hello:

Please check out Surgical Weight Loss Specialists in Norwood, Ma. LapBand is all that they do, so they're experts with the insurances and of course with the care of their patients too.

Their website is www.massweightloss.com

I cannot say enough good things about Dr. Glasgow and the staff over there.

Good luck!

Sue

[klawson617 2]

Please check out Surgical Weight Loss Specialists in Norwood, Ma. LapBand is all that they do, so they're experts with the insurances and of course with the care of their patients too.

Their website is www.massweightloss.com

I cannot say enough good things about Dr. Glasgow and the staff over there.

Thanks, Sue! I will make sure to call them tomorrow.

[NWgirl 574]

high cholesterol and high blood pressure are considered co-morbidities, esp if the insurance company is paying for meds. the whole point of submitting is so insurance can decide if the procedure is medically necessary- not only for your health, but for their pocket book. It's a lot cheaper to pay for one surgery than to pay for all of the preventable health problems.

I personally gained 10lb before my initial assessment because I too was in the 38/39 BMI and had borderline high chol/high bp but am not on any meds. I was approved the first try with anthem bcbs.

[klawson617 2]

Hello:

Please check out Surgical Weight Loss Specialists in Norwood, Ma. LapBand is all that they do, so they're experts with the insurances and of course with the care of their patients too.

Their website is www.massweightloss.com

I cannot say enough good things about Dr. Glasgow and the staff over there.

Good luck!

Sue

Sue, I can't thank you enough for your recommendation. I had my initial consult with Dr. Glasgow yesterday and things are moving along. I love the fact that his clinic's specialty is solely the Lapband. Next will be my appt with the nutritionist and psychologist. If you don't mind, would you mind sharing your experience (i.e. how long the whole process took from initial consult to surgery, challenges, post-op, etc.) working with Dr. Glasgow and his staff? We can do it offline if you prefer.

[honk 780]

Did you speak with your insurance yourself to see what their requirements are for lapband? They can tell you whether they will pay for surgery under 40 bmi.

[Sue Magoo 71]

Sue, I can't thank you enough for your recommendation. I had my initial consult with Dr. Glasgow yesterday and things are moving along. I love the fact that his clinic's specialty is solely the Lapband. Next will be my appt with the nutritionist and psychologist. If you don't mind, would you mind sharing your experience (i.e. how long the whole process took from initial consult to surgery, challenges, post-op, etc.) working with Dr. Glasgow and his staff? We can do it offline if you prefer.

Hello:

My band was placed almost five years ago. Because my BMI was so high I didn't have any waiting requirements. I saw Dr. Glasgow the first time in April 2007. I was banded in July. There were several appointments between the initial consult and the surgery. In addition to seeing the nutritionist and psychiatrist I also had a sleep study. Dr. Glasgow and his staff are fabulous! They seem to genuinely care for their patients and they make you part of their team. Dr. Glasgow will give you his cell phone number and email address so that you can reach him during off hours in an emergency. They're all very down to earth folks. They treat you like family.

Let me know if you have any other questions.

Take care and best wishes!

Sue