Newbie Question:

ShayDee · August 15, 2006

Hi. I'm new to the forum and I'm researching lap band surgery, trying to have it done by the end of the year. I was wondering, how long does your weight have to be documented before being accepted for the surgery or what are some of the requirements to be eligible besides the BMI?

Thanks,

Shannon

beachgirl · August 15, 2006

If your having done in the U.S. my knowledge is 40 B.M.I. or if less than 40 you must have at least 2 comorbities. Now in Mexico you can be as little as 40 pounds over weight. There is probably more people on here with more knowledge than me on this subject. I was a 39 Bmi and I have BC/BS and they were going to make me do supervised diet for 6 months and other stuff so I just went ahead and self paid in Mexico, plus the surgeon there, Dr. Sanchez had done more than any of the 4 doctors I talked to here. That's just my experience.

Alexandra · August 15, 2006

Hi. I'm new to the forum and I'm researching lap band surgery, trying to have it done by the end of the year. I was wondering, how long does your weight have to be documented before being accepted for the surgery or what are some of the requirements to be eligible besides the BMI?
Thanks,

Shannon

Hi Shannon,

These are requirements that vary depending on whether you're self-paying or trying to have insurance cover it. And then it varies from insurance carrier to carrier. Call your doctor and insurer and see what they say.

My carrier was one that sets a high bar when qualifying people for bariatric surgery. They say that the BMI just be >40, or >35 with comorbidities. The patient must show that he or she has been morbidly obese for at least 5 years and be able to recount other attempts at weight loss and control. There must be a recent 6-month attempt with doctor supervision, and of course the usual nutrition and psychological evaluations.

My guess is that if your carrier covers bariatric surgery, their requirements couldn't be any harsher than these.

ShayDee · August 16, 2006

Thanks for replying, I appreciate your insight.. just wondering, does the documented weight loss have to be 6 consecutive months or ?

I had seen my PCP for 3 months after gaining 30 lbs in one month and he couldn't figure out the problem, he literally told me "You need to find Jesus".. so I got a second opinion and found out I had hypothyroidism and in order for medicaid to pay for my medicine, I had to go back to my PCP and have him write the prescription.. so I wasn't documented for atleast 2 months and now I've been documented for 2, almost 3 ( if this makes any sense to you, lol )

Alexandra · August 16, 2006

Again, that depends on your carrier. If you're going to a surgeon with cash in hand, there will be no requirement for any documented past attempts. That is strictly an insurance hoop, and not all carriers have it.

And holy cow, what kind of doctor would tell you to "find Jesus"? I hope he meant that figuratively. :rolleyes: Anyway, treatment for hypothyroidism wouldn't count as a documented attempt at weight loss; it's just treatment of an unrelated medical condition.

Are you seeking insurance coverage? Have you spoken to your carrier?

ShayDee · August 17, 2006

Insurance coverage isn't really a problem, they already said they'd pay for gastric bypass or lapband surgery... I was just curious as to what requirements they deem nessacery to have the surgery because I really really want it. I think it's truly the only thing that will help me lose weight at this point.

LapBandit · August 17, 2006

My insurance didn't require any official documentation other than a questionaire that I filled in. Alexandra is right...the different requirements will vary greatly from doctor to doctor and insurance to insurance. The best thing to do is go ahead and get in with someone and see what happens. Best wishes!