Unethical bandsters?

[Elisabethsew 50]

I am not a fan of insurance companies but I don't believe it's ever OK to "nudge" (A.K.A. CHEAT) the system. I had a BMI of over 50 and had to fight to get my surgery. I FINALLY won the appeal although it delayed my surgery by several months. Call me old fashioned but I still believe it's best to be honest... easier to sleep at night.

[maryb 1]

I personally would not lie or try to cheat the system because insurance fraud is against the law. I also do not cheat on my taxes. I thought I was not a candidate for surgery because I was not 100 pounds over weight. When my Doctor told me I was a candidate, I checked my insurance company and found out that I would need 2 co-morbidities for my insurance to pay. Since I knew I only had 1 co-morbidity, I didn't bother to attempt to file with insurance. I accepted the fact that if I wanted it done I had to pay for it...so I did.

[NewSho 20]

I'm pretty sure I was gambling with my health everytime I swallowed a quarter pounder with cheese, French fries, and coke.. Make that super-sized please!!

Hmmm, I've NEVER eaten a Quarter Pounder with cheese in my life. I haven't had a Coke since I was 8 or 9 years old. No fries in years - yes, seriously, years.

Yet I'm still fat. That's totally unfair. I'm not blaming anyone but I refuse to stay obese.

Come on!!!! Can't we take a little responsibility for the health problem we created for ourselves????

I take tons of responsibility for my health. That's why I'm here. How 'bout you?

No Insurance company ever crammed food down my throat nor did the weight magically appear without me looking!!!!! .../quote]

Ah, yes.

Well, being fat is certainly something I know lots about. But in addition to my own user-created fat, unlike you I HAVE had the magical experience of watching weight magically appear without me looking:

• A particularly great example when I was given massive doses of cortisteroids (like a mega form of Prednisone) in repeated courses. . Funny how life-saving medication was so bad for my waistline. And it was not temporary gain.
  
• Let's see, Renal Dialysis used to put 8#-12# of weight on me PER SESSION. (They weigh you before and after and these were 2-hr session). Gee, That's was fun.
  
• Oh let's not forget that I was so sick I couldn't eat solid food or drink even Water for several weeks. The saline solution and glucose Fluid IV's were good for a couple a pounds a day. And yet I couldn't eat a single thing. Nice!

Never gained weight without eating? Good for you. But don't assume it's not possible and though it may not cause obesity, it easily can take a person from overweight to obese with little caloric effort on their part. I know because I lived it.

Happy Band (And Life) Journeys To All...

[lotsofkids 0]

In General.......peoples behavior reflects a trend in how they view life.

Does the system owe me something? vs the rule follower.

Of course being desperately overwt can be pretty compelling so I would not be too hard on someone who NEEDS the surgery.....but if you are someone that always follows the rules and gives back the cashier the excess $5 she mistakenly gave you.....well, I doubt you would fill your pockets with sand and try to cheat the system.

On the other hand......many people feel they have paid their dues...and it is within their right to have the insurance company pay for the surgery.

Who is right? and who is wrong? I dare not make that judgement.....it is your own personal comfort zone and what you are willing to live with within your concious. (but I would be disappointed if it were only a cosmetic issue and someone is causing my insurance rates to increase by their actions)

If your doctor feels you are a solid candidate and might benefit greatly from a lapband but the insurance company doesn't want to pay.....then how do you view things? It is a tough call......personally.....I don't blame anyone...but I do feel that I must try daily to be an example for my children. They are a mirror of their parents......and I would not want them to ever see me stretching the truth for any reason.....it is my duty and responsibility to raise them within such standards...and hope they will take the higher road during their lifetime.

Ok...I just stepped off the soapbox (oops....watch out....the first step is a doozey! LOL)

smiles....diane : )

[Wheetsin 714]

Yes, honestly it does seem judgmental - you've got your band and congratulations. So ruminating on how others get theirs does seem a teensy bit critical.

No judgement at all, and no real rumination, either. I have my band, you are correct. Having a band does not mean I'm judgemental of those who do not. I'm probably one of the least judgemental people around. If I had intended to be judgemental, you would have read a very different post. I saw a behavior and was curious about it - wanted to gain some additional perspective. If you interpret that as being judgemental - then you interpret it as being judgemental. I said it wasn't intedned that way, and it wasn't intended that way. *shrug*

[Boo 3]

Great thread, Wheetsin!

I totally agree with Amy, "FunnyDuddies." A huge part of the appeal of the lapband , for me, was to limit or stop the continual weight gain. I didn't want to develop the co-morbidities. Also, the idea of banding teens to prevent MO is really interesting. It could completely change their lives.

Sho, that is so frustrating to have the rapid weight gain as a side-effect of life-saving treatment. I do know what that is like, and it totally sucks! I thought it would be temporary because it came on so fast, but even years later, it is still hanging on. But even so, I am so grateful to be alive! At least it looks like you have your weight back down again.

Personally, I fudged 1/2 inch on my height on my initial application. When I went to my first appointment to be weighed and measured, I stood tall and to my despair found out I had shrunk 1/2 inch and my height was correct. Karma!

[JMO 0]

1st off the first dr. I talked to say no to me because I did not have a BMI of 40 (20lbs away). I said, but The only reason I weigh this is because I am at WW and I have the card to prove I have just lost this weight. He said NO! (Not because he was a jerk, it was the ins. rules) So 4 months later and 24 lbs heavier with a diff. ins company I qualified!!!

I think it is crazy that I am overweight, and have been my whole life and I can prove it, but because i was on a diet and losing i could not have the surgery. I didn't think to put rocks in my shoes or I would have because now I have more weight to lose but I sure had FUN gaining it...

There are going to rules in everyones lives, some rules are stupid, some we hate but they will always be there. I don't fault the ins company, they have to have a cut off and i am sure that they have done ect amounts of studies to find that point, but its up to us as individules to decide if we are going to follow those rules. I don't feel I cheated the system one bit. I had to have a BMI of 40 for the surgery and That is just what I had. (40.2)

[lotsofkids 0]

Wheetsin.......I think most of us are just enjoying an interesting thread.....it makes us scratch our heads...and also realize that there are many roads leading to a lapband.

I think the most important thing we must all remember in the end....is once we are lucky enough to be banded.....albeit, insurance...vs self pay vs Mexico...or whatever...is that we use this opportunity to succeed and not cheat "ourselves" with french fries or icecream or whatever bad habits we found challenging!

And hopefully we will all rally together here for great support and results.

I personally think this is a super thread.... thanks Wheets!

Pass the cyber chocolates.....(my err....um....bad habit LOL)

smiles...diane : )

[Barb 0]

I don't always agree with the laws, regualtions, policies........

But I choose to follow them even when I don't agree with them.

[Randi 0]

It seems way too easy to take the moral high ground, especially when you're already banded or you meet the BMI or weight requirements for the band. I think it better not to judge until you walk a mile in the other person's shoes and go through THEIR daily struggles with obesity.

Comorbidities or not, it's a personal choice how one chooses to go about getting the band. For those who can afford it, that may mean a trip to Europe where banding is done as a means of prevention. However, I will not judge those who can't and must rely on the grace and, sometimes, arbitrary rules of their insurance carriers, but feel strongly about getting their health and their lives back on track.

[pplqueen 0]

While the healthcare system is not perfect, it certainly beats nothing. when I first started reading this, as a christian, I thought "No way, it would never be right to cheat the insurance company." Then I thought back to my breast reduction 5 years ago. The doctor told ME that I had back pain, shoulder pain, etc..... So he could get my insurance company to approve it. Guess what, I went along with it. So... I did kinda of slide one past the insurance company before. Btw, I has 6 pounds of breast removed........ I really needed it. However, Any person that stays 60,70,80 pounds overweight for years is GOING to have co-morbidites eventually. The insurance companies are CRAZY not to relax the guidelines. I am more concerned about people who eat, eat, eat and have NEVER EVEN ATTEMPTED to lose. I know some of those. Those people should not be able to get insurance to pay. I love the rule about 6-12 months of trying/doctor followed. Why should and insurance company pay when someone has never even tried. I met a lady the other day that says that she really wants the surgery but she does not want to work with a doctor for 6 months and make an attempt. HER INS WOULD COVER IT . So I say stay fat and be miserable. Sorry to chase rabbits.... I don't think that cheating is ever right or ethical. Unfortuntately many times we all do it.... taxes, speeding, etc.... I can't judge those who do. If you live in a glass house, don't throw stones.

[cashley 0]

I don't always agree with the laws, regualtions, policies........

But I choose to follow them even when I don't agree with them.

So you always follow laws, regulations and even just policies? Never speed? Jay Walk?

[Alexandra 55]

I know you work in the industry but the first doctor I saw said "Absolutly not for a BMI of 39... he said "Go and gain the weight and come back"

I also thought he was a jerk and that's why he didn't do my surgery.

Cashley, we're not talking about whether a doctor will do the surgery on someone with a BMI of 39; that's a professional decision any doctor has the right to make. You can ALWAYS find another one who will.

The question at hand is whether it's right to deceive an insurance carrier into footing the bill. And I believe it is not right--it exacts a toll on society at large. Insurance fraud, because it's so rampant, hurts EVERYONE.

Earlier I said that for someone with a BMI of 36 who is otherwise perfectly healthy, bariatric surgery is not medically necessary. I should amend that and say that it's not medically necessary for the purposes of insurance coverage. It may indeed be advisable for the person to be banded; that's a medical decision she and her doctor should make. But *I* certainly don't want to pay for a surgery that, according to the rules currently in place, is considered cosmetic.

But no one is saying that anyone who wants one shouldn't pursue getting banded. It's just a matter or whether insurance--i.e., someone, everyone ELSE--pays for it. And for that, there MUST be lines drawn.

[barbara465 2]

As I look at 5 puncture wounds in my tummy the enormity of the act of getting a lapband has hit me. This surgery should never be taken lightly or for frivioulous reasons. This is a life altering, major surgery type of solution. I for one, believe the guidelines are there for a reason.

On the day of my surgery I saw a woman who was getting a lapband. I turned to my DH and said why? I thought she must be having hers replaced. It surely couldn't be because she was fat. Later, my DH told me while talking to her husband, that she was 68 lbs overweight. She had a tiny frame and wanted the extra weight gone. I don't know this woman's background, but I would have questioned did she try everything else?

Our insurance system is not the greatest. It is all we have until we collectively get changes past. In the meantime, we should live by the "laws" we are given and help make. Without the guidelines I'm afraid of who will want the surgery to achieve perfection. This surgery should not be taken lightly.

[Dianechef 3]

Great thread! I have been thinking a lot about this very thing ever since my recent experience trying to get insurance. Get this -

I had my insurance man at my house & we were filling out all the forms to see if we could qualify for the insurance. One of the questions was - "Have you had any type of surgery in the past year?" I put down a YES & then started answering the questions next to it explaining what kind of surgery it was. The insurance man stopped me. He asked me what kind of surgery I had. I explained to him about the lapband surgery. He stammered a little & then took the paper away from me & gave me another one. He suggested to me that I write a NO in that section. I was STUNNED!! I am an honest person & was feeling very, very uncomfortable about marking a NO. He explained to me that we weren't cheating the system, we were just letting them know that I was indeed healthy. He knew that last year the insurance company had turned me down because of my weight. Now that I had lost weight, he knew that they would still turn me down because I had surgery. He said that because I was a self-pay in Mexico that there are no records in the US proving my surgery & that as long as I continue to go to MX for my after care I shouldn't have to report it.

This system is so FRUSTRATING!! It seems as if everyone is trying to deny you for everything because they don't want to pay for it!! I can easily see why people would want to put rocks in their shoes & do all that crazy stuff. You mean to tell me it's healthier to gain 20 lbs. just so the insurance will cover you?!?! SOMETHING IS VERY VERY WRONG ABOUT ALL OF THIS!!!

It seems like the system is cheating US, not us cheating the system!! :tired