ky1985 0 Posted December 6, 2012 I have my first appt on the 18th. I'm very nervous, yet excited. I am recently married, I'm 27, and weigh 241, and am 5'9. (I'm a male). I've battled with my weight for as king as I can remember. I have high blood pressure, high cholesterol, seizure disorder, back pain, and has a stroke in 2009. I am also on cumadin due to the stroke. I've tried to lose the weight and have been able to lose about 17 and then I get stuck and can't lose anymore. I may not be as overweight and others may be, but my primary care doctor and I feel this could be a positive change for me and expand my life. I have Medicare with Medicaid. I'm wondering if anyone has been in a similar situation as mine and what to expect. I guess I'm nervous that I won't qualify and insurance will deny me, although my primary care doctor and where I am going for LapBand assure me I do qualify. Any suggestions? Also wondering the general appts you have that authorize the surgery besides the 'diet Dr' and nutritionist. Thanks!!! [ATTACH]25366[/ATTACH] Share this post Link to post Share on other sites
pinkcess 12 Posted December 6, 2012 Hi! Im in the process if getting ready for lap band too. I'm also 27 and have high blood pressure and some other things. My insurance and surgeon require several things be done before surgery... A 3 month dr supervised diet, an EDG/stomach scope, sleep study, psych eval, nutritionist appointment, information seminar, and a pre-op support group visit. Im hoping to be banded in February. Fingers crossed 1 ky1985 reacted to this Share this post Link to post Share on other sites
Allen J. Oh 7 Posted December 6, 2012 Hi -- I'm also a male, a little older than you (39), and pretty similar in BMI (5'11.5", 252#, though I was 263# at my first consult). I'm getting banded 12/27. Based on your BMI and your comorbid conditions (hypertension, high cholesterol), you should qualify. My insurance carrier, and I think this is typical, requires either BMI > 40 or BMI > 30 with at least one comorbid condition. Things to expect -- you should expect to have to jump through a number of hoops to qualify for insurance coverage. These will vary from carrier to carrier, and can even change (as was the case with my carrier). For me, I needed to attend six consecutive months of dietician visits and get clearance from her to proceed. You will almost certainly need a psychological evaluation, which is typically a few hours spread out over two or three visits. I had two consults with my surgeon: one to discuss and decide on which surgery to have, and the other to learn more about what actually happens during the surgery, how to take care of myself afterwards, etc. Only the second was required. I also had to do a nurse consultation, which mostly focused on aftercare and, honestly, largely duplicated the information I heard from the surgeon. I will also need to do a pre-operative physical with my general physician within a week before surgery. This is just how my surgeon does his surgeries. Every clinic has a different approach, but hopefully this was helpful. 1 ky1985 reacted to this Share this post Link to post Share on other sites
marfar7 1,533 Posted December 6, 2012 Medicare doesn't require any pre-op diet. I have Medicare and was approved quickly. They also require an overnight stay in the hospital. And....just an fyi: Medicare only covers fills for 1 yr. Then it's out of your pocket. I don't know what the Medicaid rules say, just Medicare. They also require a BMI of 40 or >35 with at least 1 comorbidity. Good luck! Marci Share this post Link to post Share on other sites
Banjo257 920 Posted December 8, 2012 Very best of luck to you! Share this post Link to post Share on other sites
