Lots of questions! Please help!

[amandalnygaard 0]

Hello, I am looking at having LapBand done in Park Rapids. I have BCBS ND insurance and am wondering how the approval/denial process works with them. If anyone has any insight, it would be much apprecaited. I'd love to know what kind of paramaters they use to make their decisions and what kind of luck you've had. If insurance won't cover me we are going to pay cash. Has anyone here done that? If so--if you don't mind my asking--how much was it? I've heard lots of different stories online, but would really like some local feedback. I've also read conflicting stories about how long the hospital stay was. I thought I read on one board that someone had the LapBand and then went hom the same afternoon, but I've also heard that people have to stay 3 days! What is normal? What kind of luck have you all had with the LapBand--do you recommend it? I've been overweight all my life and have tried every diet plan under the sun. I'm ready to take the plunge and rid myself of all this extra weight! Your input would be much appreciated. Thanks for your time!

[Misty Cook Kindle 0]

Hello I've had my LB on 3/27/2008 and I highly recommend it. I've lost 38 lbs. I stayed in the hospital overnight and the surgery wasn't bad at all. You are a little sore. Fill free to email me @ mistydcook74@yahoo.com

[thewired1 0]

Amanda, I have BCBS ND. The approval process can be a bear if you don't have at least one co-morbidity, even if you hare 100# overweight. I can walk you through the process as it went for me, although the process went fairly quickly for me as I had a few co-morbidities.

First: Meet with the Bariatric Coordinator. You may have to fill out some paperwork at this meeting or before it. It's similar to filling out a medical history form but it also focuses on your weight history and attempts at losing weight. If the coordinator believes you are a good candidate, they will set up your first consultation with a surgeon. The coordinator will probably push for a sleep study. If you snore, this will be covered by your insurance. Your primary care doctor will need to call in the referral.

BCBS will only pay for your Gastric Emptying study, if you're found to have less than normal gastric emptying. It's one of two of Altru's required tests that your insurance will only pay for if something is wrong, even if they've already agreed to pay for the surgery. The other--I forget the name of the test but it's where they look at your esophagus, stomach and upper intestine. If you're having heartburn (or in some cases excessive hic-ups) then BCBS will pay for this. They will also pay if anything is found during the test.

A lot of the people in my classes had to go through all three before they got their pre-approval for surgery. I don't know if Park Rapids has the NEW Start program but that was required by Altru and is never covered by insurance. $350 for it and honestly, it's a good program that is a combination nutrition/exercise class & group therapy session for 12 weeks. For me: I picked up some healthier eating tips, learned some fun exercise that I wouldn't have tried on my own, and reminded me that I wasn't alone in what I was doing. But that last one is what this forum is for!

Do you know if you have any co-morbidities?

[amandalnygaard 0]

Thank you both so much for your replies! I am 26 years old and have been on blood pressure medication for over a year now, although I'm not sure that qualifies. I also have bad knee problems--again, not sure if that qualifies. My BMI is 36, so it's not high enough for me to qualify on that alone.

The things that really bother me are that my mom has been diangosed with diabetes, my dad has had high blood pressure since his 20's, i have 2 grandpas that died of heart problems at ages 34 and 65. I have tried over and over again to lose weight, basically every program/pill/diet you can think of (like most of us all have, I'm sure) and it just won't come off. I usually lose 10-15 pounds and then 4 months later have gained it all back an then some!

I have my consultations set up for the psych eval and my initial consultation with the doctors office in park rapids.

[thewired1 0]

I'm sorry I forgot to mention it! The Psych eval and the Behavior Change classes should be covered by your insurance regardless of if they give you pre-approval for the surgery. They count as therapy sessions, which BCBS is really good about covering.

I believe the high BP is considered a co-morbidity. So his your family history of diabetes & heart disease. Have you ever been told you have pre-diabetes? That can help you qualify too.

[amandalnygaard 0]

No--never been told I have pre-diabetes--did find out that I also have high cholersterol today, though. I really hope I get approved, but it will be a while before I find out, my consultation isn't for another month still.

Thanks for those of you have taken the time to respond--I really appreciate all the help you've provided.