Consultation appt made

[TheWatcher 1]

OK to after the consultation what hoops am i likely to have to jump through... My doc said they may be hesitant cause the only things that im being affected by is bmi over 60 and sleep apnea. So other than the psych eval whats test and things are they likely to run???:ranger:

[WASaBubbleButt 41]

It depends on your doc and your insurance company. They may both have specific requirements. Each doc is different.

You already know you have sleep apnea so you'll likely have to go to a nutritionist so they can tell you your diet is bad. Then you'll have to go to a psychiatrist/psychologist so they can tell you that you have an eating disorder. Then you'll have to go to a bariatric surgeon so they can tell you that you are fat. Then perhaps a six month medically supervised diet. Some have to try to lose weight, others MUST lose a certain amount of weight such as 5% of your excess weight.

As you can see, it is clearly money well spent.

[TheWatcher 1]

great i dont have a eating disorder... 5 generations of my family both sides are fat.... and i just cut out fast food all together and lost 35lbs .... they are gonna piss me off....six months of a diet... ftlog please tell me thats an exageration .... Does this happen with most cases... anoy one else have a similar experience or one thats different......

incase it helps im 24 in the bayarea ca and i have blue cross of calfornia hmo:ranger::faint::help:

[WASaBubbleButt 41]

great i dont have a eating disorder... 5 generations of my family both sides are fat.... and i just cut out fast food all together and lost 35lbs .... they are gonna piss me off....six months of a diet... ftlog please tell me thats an exageration .... Does this happen with most cases... anoy one else have a similar experience or one thats different......

incase it helps im 24 in the bayarea ca and i have blue cross of calfornia hmo:ranger::faint::help:

If you don't have an eating disorder then how did you become obese or morbidly obese? If it is just fast food then why would you need a band? Just don't get fast food anymore. If it is genetic and a very slow metabolism, if you are only eating 800 calories daily and still gaining weight then a band won't help you.

If you are like the rest of us you eat too much and you can't control it without surgical intervention. That is an eating disorder and eating disorders run in families. Allbeit genetic or behavioral that's the trend.

It isn't easy being honest that there is a portion of our lives that we can't seem to control. If you can can control it you don't need a band. If you can't control it you need a band.

First thing you need to do is verify if your insurance will even cover Weight Loss Surgery (WLS). If they do then the next step is to see which procedures they will cover. Not every insurance company covers banding, some will only pay for bypass (for example). Some will only pay for banding up to a certain BMI and then if you are larger than their stated BMI they won't pay for anything other than bypass.

If they cover banding then you need to find a doc and get this going. If your policy requires a six month medically supervised diet you can't miss an MD appointment even once within that six month time frame. You have to have medical documentation on your weight loss efforts every single month or they can make you start all over again if that's what they choose.

My insurance covers banding but I didn't want to jump through those hoops. The unnecessary diagnostics and the supervised diet. So I just went to Mexico and got it done. Had I gone through my insurance I would just now be getting banded. Instead I'm almost to goal. Best money I ever spent.

I would suggest reading through this link:

Obesity News & Weight Loss News & Fitness News from Medical News Today

What is your BMI? That matters for insurance purposes too. You can calculate it here:

Barix Clinics - Is Surgery Right For You - BMI Calculator

[TheWatcher 1]

I am obeast as people call it because food was my out i was Depressed for the better part of the last 15 years... so when i was at my lowest i could always count on food to be a support. it was kepf fairly managed through school due to the fact that i was a jock ... football backetball wrestling badeball track and feild(shot put)... do i really didnt matter what i ate but i was still big. :ranger:

My problems started when i was outta high school for the most part i didnt work out near as much...:ranger:

The other problem is that comming from a large african american family when we get together its a soul food buffet and its only recently that we have started editing the recipies to be more health smart.:hungry:

Now after i got over the depression i still had to deal with the bad habbits that i picked up from depression. But now that im actively trying not to overeat and make better decisions about what i eat its talking its own toll but there still change i need to make. i believe by biggest obsticle to my weit gain was the depression and thats done with.:cry:think

I have already confirmed that the lap band is covered by my insurance. my pcp has already set me up with a consultation thus the thread and coincidently its the same Dr. that was at the first seminar i went to.:whoo::clap2::heh:

[WASaBubbleButt 41]

What is your BMI?

Using food during times of depression, anxiety, when you are lonely, bored, etc... all symptoms of an eating disorder.

If your weight is the direct result of depression and you are not depressed anymore then you wouldn't need a band. See what I mean?

The reason I'm pushing the eating disorder issue is because the actual surgery for banding is a piece of cake. The head games you play after surgery is when it becomes tough, that's the real challenge. Justifying food (such as depression, anxiety, personal loss, boredom, etc.) is something we all do and that's what makes us different from naturally thin people.

Personally I couldn't do this without a band because I do have an eating disorder. I can't quit stuffing my face without the band.

You say that you are over the depression issue. Are you taking meds for this? The reason I ask is because some meds for depression can actually make you want to eat more.

[TheWatcher 1]

according to one of those calculators 62.

yes but if u have no controll during a depression and u now have more control then that would make it a mental disorder. at least in my book...

not i got help and got over it... i came to terms for the reason that i was depressed now im just angry... the depression has gone... im back to my old cocky borderline arrogant self again.... its actually a relief. i feel like my life is getting back to normal....

and the reason i need the band is so that i can stop the scycle of obesity in my family. cause even if i control my of weight i will only go doen to a point usually i do well all year and then the holidays come and i balloon back up... the holidays for me represent a onset of the most delicious soul food in existence skinny people come to my familys holiday parties and leave heavier.

[WASaBubbleButt 41]

according to one of those calculators 62.

yes but if u have no controll during a depression and u now have more control then that would make it a mental disorder. at least in my book...

not i got help and got over it... i came to terms for the reason that i was depressed now im just angry... the depression has gone... im back to my old cocky borderline arrogant self again.... its actually a relief. i feel like my life is getting back to normal....

and the reason i need the band is so that i can stop the scycle of obesity in my family. cause even if i control my of weight i will only go doen to a point usually i do well all year and then the holidays come and i balloon back up... the holidays for me represent a onset of the most delicious soul food in existence skinny people come to my familys holiday parties and leave heavier.

With a BMI of 62 have you verified with your insurance company that they will still band you? Some insurance co's are amazingly stupid and anything over a BMI of 50 they will only pay for bypass. I still haven't figured out their reasoning behind that one but that's what they do often times. It's just another thing for you to research. Don't just call the insurance company, look it up on your policy and read it with your own eyes.

You have the same issue as the rest of us. You can't stop eating on your own, thus... the band. If you could control your eating behaviors over the holidays or any other time you would but you can't. That is why you are just like the rest of us.

Most of us can lose weight but we can't keep it off. Eating is a compulsion and it's very difficult to overcome that kind of issue. Many compare it to telling an alcoholic they can only have one drink daily but they MUST have that one drink daily. Well, for an alcoholic one is too many and 100 isn't enough. I think the same kind of concept applies to us as well. One bite is too many and 100 isn't enough. Yet unlike an alcoholic we HAVE to eat to survive. It would be easier to just cut out food completely since we typically are "all or none" kinds of people. But that isn't possible so it merely means we have a few challenges others don't have.

I don't really look at our type of eating disorder as a mental problem. I have read too many studies that show very clear biological differences for our complusion to over eat. Everything from hormones, brain activity, type of bacteria in the intestineal system, pancreatic issues, studies showing how MO diabetics respond to bypass procedures... I can go on and on. Thin people stop eating when they are no longer hungry. We eat until we can't possibly cram one more bite down. We can eat until it hurts and then we eat some more. That isn't depression, that is an eating disorder. Maybe it's a matter of what came first, the chicken or the egg. Depression/eating disorder. Either way it isn't something to be ashamed of, it just is. It is probably one of the least socially acceptable disorders out there. It's PC to make fun of a fat person, it's a horror to make fun of a 78# anorexic. That doesn't help us any.

Tell me something, when you eat Breakfast are you thinking about what you'll have for lunch? If you are eating lunch are you planning dinner? If you are going to go to a restaurant do you stop and think about what you will order before you ever see the menu? Thin people don't give it much thought until they are in the restaurant looking at the menu. We are planning what we will eat the morning before we go to dinner.< /p>

Do you eat when your stomach isn't really hungry? There is more than one kind of hungry. There is stomach hunger and head hunger. Our issue is typically head hunger. We aren't hungry, there is no stomach pain associated with hunger but we see that chocolate cake and we want it. We don't need it, we aren't hungry, but it tastes good, the texture of the frosting is creamy, the aroma is fantastic. We aren't actually hungry but we just want to eat anyway. Does this describe you?

Anyway, it seems to me your next step is to read your insurance policy for yourself. Don't depend on what the ins co says when you call them on the phone. Look it up for yourself. Verify everything. See if they cover bands, see what their requirements are, see if your BMI fits in with their criteria for banding vs. bypass, and most of all at this point, see if they require a six month medically supervised diet. If so, you need to get to that appointment and get it started. Have your doc document your weight and get a copy of the office notes each time you go there so you can prove you were there. Some people do all the diagnostics such as the sleep study, nutrutionist eval, psyc eval and THEN they discover the six month medically supervised diet. So get that diet going just in case it is an issue otherwise you'll have to start all over and do it again.

[TheWatcher 1]

so u bane blue cross of California then thats what im getting since you are telling me that insurance co's all at the exact same way thats what i getting from you... and i honestly dont believe that all fat people have a eating disorder and that all fat people are fat for the same reason...

im just saying just cause a dr or a therapist or a nutritionist says that you have a disorder don't make it the truth

[WASaBubbleButt 41]

so u bane blue cross of California then thats what im getting since you are telling me that insurance co's all at the exact same way thats what i getting from you... and i honestly dont believe that all fat people have a eating disorder and that all fat people are fat for the same reason...

im just saying just cause a dr or a therapist or a nutritionist says that you have a disorder don't make it the truth

Are you asking if I "blame" BC/BS of CA for something? Of course not. I never made any such claim. I told you what SOME insurance co's require and how SOME of them work. I know nothing about your particular policy. I never once claimed they all do things a certain way. Please reread my posts, I never claimed they all do any such thing and I have no idea where you get that idea from. It certainly wasn't anything I wrote.

If you don't feel that your inability to stop eating and lose weight is an eating disorder, so be it.

[TheWatcher 1]

I wasn't accusing or trying to put words in your mouth .... its just to me it seemed that way

[WASaBubbleButt 41]

I wasn't accusing or trying to put words in your mouth .... its just to me it seemed that way

Here are some of my comments. Nothing here shows anything about your individual insurance company. I explained how SOME insurance co's work and repeatedly suggested you read your own policy and verify for yourself.

>>Then perhaps a six month medically supervised diet. Some have to try to lose weight, others MUST lose a certain amount of weight such as 5% of your excess weight.<<

>>Not every insurance company covers banding, some will only pay for bypass (for example). Some will only pay for banding up to a certain BMI and then if you are larger than their stated BMI they won't pay for anything other than bypass.<<

>>If your policy requires a six month medically supervised diet ...<<

>>Some insurance co's are amazingly stupid and anything over a BMI of 50 they will only pay for bypass ...<<

>>... but that's what they do often times ...<<

Nope, nothing in there about blaming BC/BS of CA for anything. Just how SOME ins co's do things.