red1973 0 Posted March 29, 2006 I Am New To This Forum. I Need Some Serious Help. I Have Tried Every Diet Know To Humans. Every Diet Pill And Nothing Stays Off. I Am 5'6" And Weigh 215. My Bmi Is 35. I Have The Beginings Of Diabeties, Bad Knees, Bad Back And Joint Pain. I Am A Hairdresser And Have Trouble Standing All Day With The Pain. I Have Been Fighting Being Heavy Since Highschool.(15 Years) I Dont Know What Else To Do. This Is My Last Resort. Do You Think I Qualify For The Surgery? And Do Insurance Co. Cover It. I Have Highmark Ppo Blue. I Am At My Wits End. Thank You Renae Share this post Link to post Share on other sites
Wheetsin 714 Posted March 29, 2006 Only your insurance company will know if you qualify, since they determine the requirements, and whether or not coverage is available (primarily, your employer also determines this). I'd suggest starting off by calling your carrier and asking if they provide coverage, and if so - what the requirements are. Welcome the board, BTW. Sorry I can't provide a more definite answer, but Ionly know what *my* carrier requires. Share this post Link to post Share on other sites
hairagain 0 Posted April 1, 2006 I do hear your pain and feel it too. I am a hairdresser too and have struggled with all of those issues. I guess the one thing I did to help myself was bought a really ggod mat to stand on. It cost me some $ but was worth it. I limit my work to about 8 hours per day. I was banded on Jan 19 and am down about 20 lbs but have more to lose than you do. I am about the same hieght. Iam at 255 today. I am 54 yrs old and have fought the fight of fat my entire life. I am so hoping I can succeed with the help of the band. I have had an infection in my port sight and am waiting for my first fill. I hear that is when it works. Up until now I can eat pretty much what I want to, but in samller quantities. I have cravings and struggle with that. If you want, you can contact me. My name is Darlene. Chin up, your not alone!!! Share this post Link to post Share on other sites
Dody 0 Posted April 1, 2006 Insurance seems to be a huge issue for almost everyone on this forum. A lot of people find they aren't covered, or they have to fight for their coverage and it takes a long time. A lot of people give up and self-pay and a lot of people persevere by fighting the insurance companies (kudos to them). You should find out first if your insurance covers the surgery and go from there. All insurance companies are different and I know nothing about yours. Good luck. Share this post Link to post Share on other sites
hairagain 0 Posted April 1, 2006 My insurance did cover most of my banding. I have bc cs of MInnesota. I just called the # on the back of my ins card and asked the questions I had. I was lucky I guess. Mine was covered. I was left with about $1500. Not bad considering when you self pay it is a HUGE bill and I also have coverage for any complications that can occur. My fills are covererd too for the most part. My first isn't until next Weds. I think it is worth fighting for. Good LUck!! Share this post Link to post Share on other sites
gentlespirit 1 Posted April 1, 2006 I also had BC/BS of Minnesota and ended up paying about $2500 because I hadn't had any other expenses and that was my max out-of-pocket expense per year. I'm having to make payments to the hospital, but they are fine with that as long as I pay on time. You would have to c heck with your specific insurance co. as to what they cover. And there is a separate forum on this site for insurance and coverage information/questions. If you check there, perhaps someone has had experience with your insurance company. Best of luck...hope you find out that it's covered...if not, a lot of hospitals/docs will do a discount for self-pay people. Emily Share this post Link to post Share on other sites
Hedwig 0 Posted April 2, 2006 I asked questions about insurance because my mother was intrested in the band. I myself have 8 weeks before banding, so I can only tell you what my surgeon said. first like wheetsin stated it depends on your company. but my doctor said if you have a bmi of 32-39 you have to also have other morbilities, such as being diabetic, asthma, high blood pressure, or sleep apnea. other wise the insurance company requires a bmi of 40 and up. this is just what he told me. I am self pay so I am able to be banded with a bmi of 38. I am not sure what your company requires but I would say its a good time to write down all you questions and get them answered. I hope I helped. good luck and welcome to lapbandtalk. Share this post Link to post Share on other sites