I have tons and tons of questions!

[MrsAEF 0]

Good evening, everyone!

I am a 21 year-old with a BMI of 38 and hoping to get the lap band surgery sometime in the near future. I have tons and tons of questions and I have heard that this board is incredibly helpful so here they are! Firstly, my husband and I don't have insurance yet. He changed jobs which caused us to not have insurance for a couple of months. Our new insurance is going to kick in as of June 1, 2007 and this is when I'm going to start my journey of trying to get approved for the surgery. I don't even know if our insurance covers any of it but I am hopeful and I still want to get as much research as possible within me. We are going to have UHC so my guess some of it could be covered but who knows, I will find out in June once we get our cards, info packets, etc. etc. Anywho, here are my questions....

1) It's been a little over a year since I've had a pap smear. I'm going to go once our insurance kicks in and I'm going to let my doctor know that I haven't had a period in 7 months and that I am interested in having a weight loss surgery. I'm very sure it's due to my recent weight gain, do you think she would be willing to write a letter of recommendation to the insurance company that the reason for surgery is a health issue?

2) How will I know what other procedures I need to get done before being considered for the surgery? Does the insurance company tell me this or the surgeon?

3)After that, do I just call up my surgeon (I'm wanting to go to Dr. Spivak in Houston, TX) and say "Hey! I'm interested in getting the lap band surgery!" and do they just guide me from there?

4)Is it possible to lose weight w/ out fills or are they necessary?

...Grr, that's all I can think of as of right now. I took a shower earlier and I swear that I had questions coming out of my ears! Anyway, thanks in advance for all of your help!

[MrsAEF 0]

I thought of another question!

5) I know that some insurance companies require you to have a 6 month weight loss documentation. This is no problem for me considering I have joined Weight Watchers numerous times in the past. How do I get my information from them? I have long thrown away all of my weigh-in cards but I assume they also keep them on file?

[edieparks 2]

I am going to attempt to answer one.

I think your bmi is what determines if you need WLS (weight loss surgery).

Welcome and good luck on your journey.

edie

[Betsyjane 2]

I'm a Spivak girl! You go to one of his free seminars and he will do a presentation about it and answer questions. Then, you can also pay $100 to have a private consult with him that same night, and I'd highly recommend it. He'll act like he has nothing better to do in his life than to sit and talk with you and answer questions. You can get the times of the presentations on his website.

IF insurnace covers bariatric surgery, then they will probably be looking for a BMI of at least 40, or a BMI of at least 35 with other related medical conditions like high blood pressure or diabetes. Dr. Spvak will go over that stuff at the presentation too.

Spivak requires practically nothing of you before surgery, compared with many Drs, and he'll prepare the report for your insurance company about your past weight loss attempts. His staff will walk you through it.

I'd suggest

1) Go see Spivak and let them deal with insurance and guide you.

2) Read everything you can around here and start learning. It's a journey with a huge learning curve. I'm still figuring it out, and am so pleased I did it.

3) Find a local support group for lap band and start going. (Go to the home page here and look down toward the bottom for USA Support Groups.)

Oh, regarding fills. There are a few people who lose weigh and never have to have a fill. But that's unusual. Fills are mostly no big deal, and you'll look forward to them to get just that right amount of restriction to stop your hunger and cravings.

[azmensan 1]

Mrs AEF -

Welcome to researching the Lap Band!

I'll try to answer your questions in order:

1) First, please concentrate on the fact that you've not had a cycle in 7 months. When I had that issue, it turned out that I had a tumor on my pituitary gland. You NEED to get that checked out. At a BMI of "only" 38 (which is not clinically morbidly obese, although you surely feel like it), your cycle stoppage is not likely solely due to the weight gain. In fact, a great amount of my weight was gained BECAUSE of the tumor. So PLEASE get that checked out. Many insurance carriers will NOT cover the Lap Band if your weight gain is caused by a medical condition. And it's definitely beter to get the medical condition treated first. THEN, if youstill can't lose the weight, take a look again.

2) All of the testing and whatnot you need, provided you start with a reputable bariatric surgeon, will be clearly laid out for you. Much of that testing will involve an Endoscopy, electrocardiograms, etc. etc. This will all be so that you are proven healthy enough to have the surgery. I met a guy pre-surgery here who found CANCER in the pre-surgery testing. It literally saved his life. ONce he got the cancer treatment wand was clean for 2 years, he again became a candidate for the Lap Band.

3) Your surgeon should be able to guide you - IF he is a covered physician under your health plan. UHC I think is United HealthCare, right? That's an HMO. HMOs are NOT typically likely to approve the Lap Band for those with a BMI below 40. Pleae keep that in mind. That is, unless you have some severa co-moribities, like diabetes, high blood pressure, etc. IF you are not experiencing these types of major weight-related issues, you may not even qualify as this surgery being medically necessary.

4) Losing weight without the fills would be possible, depending upon the amount of restriction the band itself provides you. BUt that is rare. Remember that the SURGERY is the big deal, NOT the fills. The fills are just a needle in a port. No big deal at all. Like giving a blood sample for a test.

5) Weight Watchers MAY have your cards in their files if your membership was recent enough. Some insurances not only require 6 months of documentation with a plan, but also along with visiting a DOCTOR every month during the weight loss effort.

Please remember that you are only 21 years old, you have a lot of years ahead of you, even though I know you probably don't feel like that right now. You want it NOW. I know. But you may have a long road ahead of you. I took about 6 years before finally deciding which surgery was right for me, my lifestyle, my psyche, my insurance coverage, etc etc.

I hope this info helps!

[Wheetsin 714]

My answers will be in blue.

Our new insurance is going to kick in as of June 1, 2007 and this is when I'm going to start my journey of trying to get approved for the surgery. I don't even know if our insurance covers any of it but I am hopeful and I still want to get as much research as possible within me. We are going to have UHC so my guess some of it could be covered but who knows, I will find out in June once we get our cards, info packets, etc. etc. Anywho, here are my questions....

If you are enrolled, and just don't have active coverage yet, you should still be able to get a copy of the SPD. You should not have to wait. (I could be wrong about this, but that's what I think, anyway)

1) It's been a little over a year since I've had a pap smear. I'm going to go once our insurance kicks in and I'm going to let my doctor know that I haven't had a period in 7 months and that I am interested in having a weight loss surgery. I'm very sure it's due to my recent weight gain, do you think she would be willing to write a letter of recommendation to the insurance company that the reason for surgery is a health issue?

First, your doctor will have to verify that your cessation of periods is due to weightloss. Your doctor won't write a letter of recommendation on your assumption that it is. General guidelines for insurance approval include history of obesity (5+ years) and BMI over 40 or over 35 with two or more comorbidities (doesn't sound like you have this). IF the periods were a result of weight gain, this might be one comorbidity, but honestly - I'm not sure.

2) How will I know what other procedures I need to get done before being considered for the surgery? Does the insurance company tell me this or the surgeon?

Usually no other procedures are needed unless you have something that has to be medically corrected before the surgery can physically take place. There are general criteria that (usually) need to be met for insurane coverage. Common criteria include 6 months of medically supervised weightloss (6 months of being weighed in doesn't normally count, they require an additional 6 months of going specifically for Morbid Obesity - 278.01), psychologist approval, standard pre-op admissions (xray, labs, etc.). These vary by surgeon and insurance company. Your surgeon will probably have a set of criteria, as will your provider.

3)After that, do I just call up my surgeon (I'm wanting to go to Dr. Spivak in Houston, TX) and say "Hey! I'm interested in getting the lap band surgery!" and do they just guide me from there?

Determine if you're covered by your insurance, or if you will be self pay. Dr. Spivak may or may not be an in network provider. If he isn't, you can either pay the difference or find someone who is. Once that decision is made, contact the surgeon's office. Most require you to attend an information seminar during which you're given the paperwork you need to begin the process.

4)Is it possible to lose weight w/ out fills or are they necessary?

You can lost weight without fills, but you shouldn't count on it. The point of the band is to be restricted. Sometimes enough restriction is given by the band itself that fills aren't needed. 95%+ of the time this isn't the case. It's safe to assume you will need at least a few fills.

...Grr, that's all I can think of as of right now. I took a shower earlier and I swear that I had questions coming out of my ears! Anyway, thanks in advance for all of your help!

5) I know that some insurance companies require you to have a 6 month weight loss documentation. This is no problem for me considering I have joined Weight Watchers numerous times in the past. How do I get my information from them? I have long thrown away all of my weigh-in cards but I assume they also keep them on file?

Weight Watchers is not medically supervised in and of itself. If it was something you and your doctor agreed on, and you were going to follow-up sessions with your doctor to monitor your progress. Weight Watchers weigh in cards are pretty much worthless as far as "medically supervised" goes. See above information.

[MrsAEF 0]

Thank you all very much for answering my questions!

BestyJane-I think it's awesome that you have the same surgeon that I am considering. All of your info helped me tremendously and I'll be sure to go to one of his seminars!

azmensan-The first thing I'm going to do once our insurance kicks in is go ahead and get a pap smear and make sure that my recent weight gain is because of me eating cakes and Cookies and not a tumor, lol. My OB/GYN told me last year that I do have a slight condtion of PCOS and this could be why but I am really wanting to go and get this under control. Thank you so much for your concern!

[azmensan 1]

Yes, PCOS can definitely cause the cessation of periods, and also can cause weight gain, chronic pain, etc. etc. For a while, that's what they thought I had. So yeah get checked out and ask for a hormone level check! If you have too much prolactin, it's your pituitary!

L

[NicksWife22 0]

MrsAEF, I have UHC and they won't pay. I am self pay. My friend, who had BCBS, had to wait over a year while she went through classes and diet monitoring, etc. I scheduled mine a month ago and I'm getting banded in 2 weeks!!! SO excited! I wish I knew a secret to help you but I don't. I hate UHC tho.

J

[Betsyjane 2]

Yeah. Spivak will walk you through the whole thing..... I'd do him first and then get your TO DO list together.

[marlynncreel 1]

One good thing about it is, you can claim the expenses on your income tax. It's a medical expense that you're paying out of pocket (even your deductible if insurance pays), and you can claim your mileage to the doctor for pre & post-op visits, fills, etc. You can also claim your airfare (for those of us who go out of the country to have it done) and any lodging fees you might have to pay. You may want to check on having it done in Mexico too, the prices are cheaper and care is still excellent!

[Lisa99 1]

We have UHC. My husband had a BMI of 42 and serious high blood pressure. UHC approved him in about 10 days. I think it all depends on whether or not your employer has a no weight loss surgery clause.

[doubletrouble 0]

Do not get your self all worked up. Weight loss is big business and big business is big bucks. These doctors want you to get approveed as much as you do. They know what needs to be done and documented to get you approved. They also know the big diagnosises that insurance companies want, ie hypertension, diabetes, sleep apnea, hypothyroid, PCOS, gallstones or gallbladder removed. Do these sound familiar to any of you. If we do not get approved the surgery they do not get paid for the surgery. These doctors have staff members that only work on getting the proper papper work processed and clients approved. I know I sound bitter but money is money regardless if it is open heart, c-sec or lapband. I love my lapband and would actually take a personal loan out to pay for it (of course if I knew at the time I was going to lose 130 pounds in 18 months I would have been more confident). What I am trying to say is show up to the appointments and they they will do the rest. Good Luck :>

[AlexisClaire 0]

This is my first day on these boards and my first day of in-depth research into getting the LapBand. I have United HealthCare through my husband's employer (Hewlett Packard) and when he called (cuz I'm a chicken) and asked he said "What do we need to do to get this surgery" and the woman said we'd need a letter of necessity from a doctor and a BMI of 40 OR a BMI of 35 with co-morbidity symptoms. Now the UHC woman didn't say anything about nutrition counselling or supervised diets or psych evaluations but that doesn't mean that your surgeon won't require them. Also, she said if we went with an in-network facility it would cost us the $40 copay for each doctor visit like normal and the actual procedure and hospitalization (if less than 24 hours) would only cost us $200 - and we have the highest deductible plan available at HP.

I must say that I am LOVING our United HealthCare coverage, they've really been an asset in all the things we've used them for - dentists, chiropractic, etc.

So all you need to do is give them a call and ask for yourself. Next have them refer you to facilities that they cover and talk to them (that's my next step for tomorrow morning!).

Good luck! Hope that was helpful.

[LovelyLaFleur 0]

For the insuranse you don't have to have all the other work ups. It depends on your Dr. I've noticed that my Dr. is much stricter than some of the other as far as testing and siet go. Good Luck