What does it take to get approved?

[treyes628 0]

Hi all,

I just got a referral from my doctor at Kaiser to get signed up for the classes and meet with a specialist. I told her that in addition to my weight (267 lbs, 47 BMI) I have chronic foot and back pain and am borderline diabetic. I asked how many people get rejected for the surgery, she said she really didn't have any idea, but the fact that I am so young (24) might not help. I just want to know if anyone has gone through the lap band process at Kaiser, your specific circumstances and what got you qualified, as well as any info that you learned along the way. I am pretty nervous that I won't be accepted, even though I'm gonna keep trying. Also, I am not 100% sure that Kaiser does Lap Band, the doc said they might only be doing the gastric bypass surgery. Any info?

Thanks!

:biggrin2:

Tiffany

[msperson 0]

Do you have insurance? Also since your doctor recommended you i would think you would be fine! Have you been overweight most of your life? I am 36 years old and have been overweight most of my life and cannot wait for this surgery! Be sure to do exactly what your dr tells you to do! The insurance company loves to turn you down if you do not do everything you are suppose to do! good luck!

[kathystrick 3]

First of all, call and get a copy of their policy on WLS. That will answer a lot of your questions. I would think that regardless of your age (there are people here your age and younger who have gotten banded), you do have comorbidities that would work in your favor. As msperson said, make sure you do exactly what it says in their policy to save yourself a lot of headaches with appeals and such. As anxious as we can get waiting for approval to amke this change once we have made the decision to do so, it only makes it worse when you are rejected because of something you didn't do.

Good luck!

[msperson 0]

Good idea! Yes make sure you get the insurance policy! My insurance company puts it online! I have a bmi of 48.8 but have no other health problems but I am considered morbidly obese so I qualify! Do make sure you do everything your dr tells you to do! I mean everything! Good luck!

[treyes628 0]

I am going to do absolutely everything Im told. My doc said I need to start some kind of cardio 6 days a week, will I still qualify if I lose a good amount of weight before my surgery? Im going to request a copy of my policy, but I know it is covered because my boyfriend who is on the same policy was approved already. Another question, will the same insurance policy cover two surgeries??

Thanks for all the great info y'all.

[kathystrick 3]

If you are both covered on the policy, it will cover you both for surgery. No different than if you both had anything else done. You are individuals on the coverage.

[msperson 0]

i dont know about if you lose to much weight. who is your insurance company? I would give them a call though! i know even if i lose 50 pounds by the surgery my bmi still qualifies me for it! good luck and if they turn you down keep trying!

[Vicki J 0]

Tiffany - First thing is where you are located. I know that the Kaisers in California are doing the lap band and I have heard that a lot of them across the US are doing them. But, the programs are different in different places.

I had my surgery through Kaiser in December. I started last June with an orientation. I had my surgery through the So. San Francisco Kaiser even though I live near Sacramento. We have 3 Kaisers in No. CA that do the surgery so we are sent to one of the Bay Area Kaisers. You don't get to choose which one you go to and they are buried.

When I was referred I had a BMI of 45.5 and was 54 years old. I don't think the fact that you are younger will be a problem since I know a few younger people who have had the surgery. Unfortunately, a lot of the PCPs don't know what the bariactric people are doing.

So, my advice to you is to call patient services and/or the bariactric unit of the hospital that does the surgery. Patient services is the best place to start because they can tell you all about your coverage and if the Kaiser near you has the program. I did this because I found so much conflicting information about the coverage. They cleared it up in a phone call.

Second, if you are in Northern California, let me know and I can give you a run down on the proceedures as I know them. You can also PM me if you would like. It's a long process but I'm happy I stuck to it.

Good luck.

[skcb05 0]

I'm in the begining of my journey.Gonna go to a seminar.