New and nervous!

jillybeano · November 6, 2007

I have been looking into this surgery for several months now and am finally ready to delve headfirst into really making it happen.

I need to gain 18 pounds to have a BMI of 40, in order for the insurance to cover it with no additional conditions.

I am willing to do that if I have to, in order to get it covered.

My question is, if the doctor says I have to lose a portion of weight before the surgery, what's the point in having gained the extra weight to hit the 40 BMI score?

Do they cover you based on what you weighed the first time you went into the doctor? Is the "pre-surgery weight loss" strictly for the doctor, or does the insurance company say, "Hey, you're not a 40 BMI anymore, now we won't cover it."

That scares the heck out of me!

luluc · November 6, 2007

Hi Jilly,

Not sure what type of insurance (we had BCBS at the time - grateful no more!) you have, but my experience was not that great - having to wait 7 months to eventually self pay. My BMI was 37, my husband 47 (both banded on the same day). We went through all the required testing (sleep/psych/blood/stress/etc). Insurance covered all those costs but in the end did not approve either of us for the Lapband Procedure. Didn't make sense to me that they paid over 8k each in testing but declined us for the actual procedure - even with co-morbids for my husband.

You'll get a lot of answers here, as I've read in the last few wks each Dr. / Ins is different. I wish I only knew I needed to self pay a yr ago and I'd be skinny now - Either way ... Best of luck!