Just starting, nervous and a bit lost :)

[Nemesis 0]

Hi everyone!

I am 32 and the proud Mumma of a very active two year old! I've been overweight all of my life but got really big during my pregnancy and haven't really been able to move past the point I am at now. I am in touch with a gal in my area that had the surgery and she has inspired me so much. I researched the LapBand last year, but wasn't really motivated.

I'm a little confused about the process with insurance. I go to my first seminar May 6th, and I'm am assuming I'll get a lot of info there. Today I spoke with someone at the Weight loss center I want to go through and she explained to me that I must have a BMI above 40 - mine is 53.8.

I have Aetna - I called them today and they said I had to have BMI above 40 or under 38 plus two co-morbidities. She also told me to go to the webpage and there is a print out about other criteria. On there it says something about being on a supervised diet for 6m. In Jan I saw a nutritionist (again) and then spoke in detail with my doctor at my physical about my weight. I went on a modified Zone diet, and got a membership at the YMCA. I lost about 15lbs and now am at a stand still - and getting so frustrated and hopeless about my situation.

Do these 4m count in the 6m diet thing? I was seen by my doctor once and I'm due to see her again in 2 weeks. I haven't told her about my choice to get the LapBand - but she did suggest it as an option in January when we spoke.

I'm going to look through the site, but it said to stop here first! Any info/advice/help/hugs anyone can offer would be appreciated :cool2:

Nemesis

[efan82 1]

I have Aetna, but my plan required 3 mos. of supervised diet. They want the weigh ins with the doctor. Mine required multidisciplinary diet, which meant dietician and an exercise person. I had to track my exercise. They didn't really push me much on the diet because they didn't want my BMI to go under 40. I actually gained during that time. I probably would have gained more if not in that program! After that, the approval from Aetna was less than one month! Good luck.

[wsw27 0]

Every plan is different. But I know my ins requires a 6 month doctor supervised diet. For me that means I have to see the doctor at least 1 x per month for 6 months, and at each visit the doctor has to record weight, blood pressure, pulse, what we discussed about the diet and the exercise plan I was following. In addition to my doctor's records, I also obtained a printout from my gym, which maintains usage reports (I have to swipe my card each time I use the gym). I also obtained records from other doctors that show my weight over the past 7 years. I don't know if this will be enough because my app't with the surgeon is two weeks away but I remain hopeful.

The surgeon's office is usually aware of what each ins company requires. You may learn more at the information session. Good luck.

[Laura_MD 5]

You are right that every plan is different, however, most have a requirement for 3-6 months of a supervised diet attempt. That usually means that you have to be seen every month by the doctor if that is the route you go. You should also know that most plans accept Weight Watchers, Jenny Craig, etc. because they are technically "medically supervised" because they are set-up by physicians.

You should also check your state laws. Maryland, where I live, has an obesity law that requires insurance plans for state (including Medicaid) and for employers with more than 50 employees to cover weight loss surgery. They only require that you have done a total of six months, (at least 3 consecutive months) in the last 2 years. I was not told that when I went to my doc though, or by my insurance. So make sure you do you own investigation and ask to see the requirements in writing, directly from your policy.

[zoomomma 1]

A good place for that info is the insurance biller at your doctor's office. I talked to mine and she said that alot of the time if you go to your doctor 1/m for 6m and just talk about diet and exercise that will do the trick.