question on getting approved for the lap band?

ericab3618 · March 13, 2008

hi... ive been considering getting the lap band done..... ive tried diets upon diets and some have been successful (only the ones that consist of starving yourself). im not sure that im "morbidly obese" i'm 5'6 225lbs, would i apply?.. i really want to get this done bc i know i can not do it myself. i have blue cross insurance......... however i just started my job in december of 07... my question is about what ive underlined and also........ does anyone know is there a certant amount of time you should be with an insurance provider before applying for surgery so they dont deny it bc they think you just got it to get the surgery??? :grouphug::confused:

abeaher · March 13, 2008

morbid obesity is defined as a BMI over 40 or more than 100lbs overweight. You can find a BMI calculator online, just google BMI calculator. According to the calculator I used your BMI is 36 ish. So according to that number you are obses but not morbidly obese, HOWEVER some insurances will aprove a BMI between 35 and 40 if you have comorbidities (high BP, diabetes, sleep apnea,etc). Every Insurance is different and getting approved can be quite the task but your surgeons office should be able to tell you what you need to submit for approval.

YOu do not have to be with an ins company a certain amount of time for them to cover you. I picked up my ins in Jan 08 and was approved the first week of Feb. If you are concerend that they will say it is pre-existing all you need is a letter of credible coverage from your previous carrier.

Hope this helps.

Thin4Anisha · March 13, 2008

Here is a link that will let you know your BMI and what classification of obese you are. The rule of thumb is if your BMI (Body Mass Index) is over 40 you are morbidly obese.

BMI Calculator

You should call the insurance company, you don't have to give them your specific policy number, just the group number for the insurance your employer has with them and ask if Gastric Banding is covered, this is your first step. If they say yes, ask what are the qualifications one will have to meet to be approved. Some have to do 6 months of a diet with a doctor, have a BMI over 40 or a BMI over 35 with comorbities (like diabetes, high blood pressure..). Also, ask if there is any waiting period from the start date of the insurance to being able to be approved for the insurance. My insurance does not have a waiting period because I was insured before switching to them so there is no break in coverage.

Sorry so long. Browse through the forums, they are wonderful and will teach you everything you ever wanted to know. There is one particulair forum you can find from the main page specifically dealing with insurance questions. Everyone on here is so very wonderful and supportive. Good Luck!!

ericab3618 · March 13, 2008

morbid obesity is defined as a BMI over 40 or more than 100lbs overweight. You can find a BMI calculator online, just google BMI calculator. According to the calculator I used your BMI is 36 ish. So according to that number you are obses but not morbidly obese, HOWEVER some insurances will aprove a BMI between 35 and 40 if you have comorbidities (high BP, diabetes, sleep apnea,etc). Every Insurance is different and getting approved can be quite the task but your surgeons office should be able to tell you what you need to submit for approval.
YOu do not have to be with an ins company a certain amount of time for them to cover you. I picked up my ins in Jan 08 and was approved the first week of Feb. If you are concerend that they will say it is pre-existing all you need is a letter of credible coverage from your previous carrier.

Hope this helps.

im not sure that i have many symptoms, i have however had my gallbladder removed a few years ago bc of a poor diet, had stones....... i do believe i have sleep apnea, i often wake up at night that i cant breathe or i have dreams that im sufficating, which i believe is bc i am actually not breathing at that time... also i ahve horrible troubles breathing after i eat a full meal

coolcrystal · March 13, 2008

I can already tell you that you are not 40 BMI and over. My sister couldn't get approved at 238 and 5'6". I think her BMI was like 38 maybe because she didn't have any co-morbidities. Yours is probaly like 35 or 36. Maybe if you had some co-morbidities like diabetes they would approve you.