New here. Already at my first bump in the road.

[GSDmomma2 1]

I am 23 with a BMI of 47. Ridiculous, I know. Anyway. I started the journey for the lap-band 2 years ago and I stopped going to my doctors appointments because I couldn't afford all the co-pays and what my insurance wouldn't cover for every little thing I had to do. (Nutritionist, sleep study etc.) Recently I learned that the Indian tribe I am apart of offers the band or the sleeve at no cost to me. First I have to lose about 10lbs to even be eligible because they only take people with a BMI of 45 or less. I'm fairly certain I can accomplish that. I will have to drive an hour each way just to visit a physician that works for the Cherokee nation, multiple times a month and then an hour and a half once a month to the hospital where the surgery will be performed for a weigh in. I will have to have the EKG, blood tests, sleep study, nutritionist and all that jazz, which is fine. I'll have to keep a detailed journal of whatever I eat. Join a support group. And then the bariatric team will review my case and if they feel I'm "worthy" basically then they will forward it on to the surgeon and he decides my fate, so to speak. I know it seems like a no-brainer and I should just do it. But it's a little frustrating to me to know that there's a 50% chance that I won't get approved. Then I'll feel like there's all those months wasted.

I don't really have a lot of co-morbities. I'm pretty sure I have sleep apnea. I snore loud (my husband has recorded me) and I never wake feeling rested. I don't have high blood pressure. I don't have diabetes. I don't have asthma. I don't have any thyroid problems. I DO have a stomach ulcer that causes a lot of trouble for me.

Basically I'm just feeling defeated and I haven't even started yet.

Anyone else been through something similar? And maybe everything worked out?

I guess you could say I need a little encouragement.

[agirlnamedfrankie 69]

I understand how you feel. I went through my insurance's requirements of six months of nutritional counseling, had a psych test (3 meetings), a sleep study (2 doc visits + the overnight), visited the support group, saw the doctor, had labs run, etc., and in the end, didn't meet the qualifications. However, I knew going in that I was under their BMI requirement and that it was dependent on co-morbidities which, it turns out, I have none of. (Yay for health?)

I don't know how much difference the Cherokee nation approval process is from that of an insurance company. Are there factors other than your BMI that they take into account? I know that in general, for insurance, as long as you're 40+ BMI, you're typically covered (if your policy covers bariatric surgery at all) and that you don't need any co-morbidities. Do you have a clear layout of how they determine eligibility? I'm guessing it's something more specific than just a 50/50 whim and that should give you a better idea of what your chances are.

Having jumped through all the hoops I did and not being approved, I'd still say it's absolutely worth your time to give it a shot. I'm going the self-pay route now and having surgery next month so I can't speak to the benefit of having the surgery, although I obviously think it's a big one since I'm going through with it (and paying) but the opportunity to have it completely paid for is pretty awesome and in the long run, probably worth the potential of wasted time.

[LisaNLasVegas 91]

But it's a little frustrating to me to know that there's a 50% chance that I won't get approved. Then I'll feel like there's all those months wasted.

Are those months really "wasted" if you lose some weight and make some positive food related choices?

I know what you mean, but you can't look at the pre-op stuff as wasted time. You will have to re-learn your eating habits before or after surgery. AND, if you are denied (I hope you are not), does that mean that you are going to throw in the towel and just quit altogether? I don't think so!

[shelz 2]

Don't give up. You may have do-morbidities you don't realize. I'm 46 years old, 5 feet tall and weigh 215. My BMI is 42. I've been pre-diabetic for 10 years and you may be too with your Native American heritage. You have sleep apnea that counts, sounds like you may suffer from GERD (I'm not a doctor)but going on my personal experience. I was approved the first time. I saw you are going through Cherokee nation. Are you in OK?

[GSDmomma2 1]

Don't give up. You may have do-morbidities you don't realize. I'm 46 years old, 5 feet tall and weigh 215. My BMI is 42. I've been pre-diabetic for 10 years and you may be too with your Native American heritage. You have sleep apnea that counts, sounds like you may suffer from GERD (I'm not a doctor)but going on my personal experience. I was approved the first time. I saw you are going through Cherokee nation. Are you in OK?

Yeah, I live in northeastern OK.

I was told I was pre-diabetic like....8 years ago. But now I'm not? I probably still am. Cause I don't think it's just gonna go away

I do have a family history of type 1 diabetes on my mother's side which is the side with a ton of Indian and heart disease on my dad's side which is mainly scandanavian. So nothing good is going to come out of me being so overweight.

Edited July 22, 2014 by GSDmomma2

[GSDmomma2 1]

I understand how you feel. I went through my insurance's requirements of six months of nutritional counseling, had a psych test (3 meetings), a sleep study (2 doc visits + the overnight), visited the support group, saw the doctor, had labs run, etc., and in the end, didn't meet the qualifications. However, I knew going in that I was under their BMI requirement and that it was dependent on co-morbidities which, it turns out, I have none of. (Yay for health?)

I don't know how much difference the Cherokee nation approval process is from that of an insurance company. Are there factors other than your BMI that they take into account? I know that in general, for insurance, as long as you're 40+ BMI, you're typically covered (if your policy covers bariatric surgery at all) and that you don't need any co-morbidities. Do you have a clear layout of how they determine eligibility? I'm guessing it's something more specific than just a 50/50 whim and that should give you a better idea of what your chances are.

Having jumped through all the hoops I did and not being approved, I'd still say it's absolutely worth your time to give it a shot. I'm going the self-pay route now and having surgery next month so I can't speak to the benefit of having the surgery, although I obviously think it's a big one since I'm going through with it (and paying) but the opportunity to have it completely paid for is pretty awesome and in the long run, probably worth the potential of wasted time.

I will have to get more details on my actual chances of getting the surgery. I'm hoping that if I show them that I'm dedicated and this is what I want that I'll have a fighting chance.

[GSDmomma2 1]

Are those months really "wasted" if you lose some weight and make some positive food related choices?

I know what you mean, but you can't look at the pre-op stuff as wasted time. You will have to re-learn your eating habits before or after surgery. AND, if you are denied (I hope you are not), does that mean that you are going to throw in the towel and just quit altogether? I don't think so!

Good point. I guess it's just easier to see the negative in everything rather than the positive.