Hello! I'm trying!!

[skep 9]

I have gone to the seminar for Lapband and had my dr. appointment today. My PCP is totally supportive. Unfortunately, the Lapband dr. does not think my insurance will cover the surgery. I have NC State Employees insurance and FEP BC/BS. The problem is that my BMI was above 35 for three of the last 5 years and the insurance requires a BMI above 35 for 4 of the last 5 years. They may reconsider if I have a co-morbidity such as diabetes or high blood pressure. The problem is that the only problem I have is my knees which are really bad. Apparently BC/BS does not consider this a co-morbidity. Any suggestions? I really want this surgery and have tried everything to lose weight which is why my BMI was low for two years! apparenatly, this doesn't matter:crying: Is there hope?

[xgrl 0]

Try to think of any ailments you have Migraines have actually been linked to obesity as well as mental illness (depression, anxiety, phobias) and so on. also i'm not sure of your age but having abnormal or painful periods has also been linked to obesity. I guess until I started really researching every thing that has been wrong in the past few years i've noticed alot more of my life is affected by my weight than I thought. Also you could try to submit and always appeal it if they deny you, the worst thing that could happen is that they say no and many people here have had multiple appeals and are more than willing to share their letters and stories to help you out. Keep trying don't give up!!!!

[vicki h 0]

I did not have any that I was aware of either, until I had a sleep study and found out I had Sleep Apnea. That is what got me approved. You never know!

[skep 9]

I did not have any that I was aware of either, until I had a sleep study and found out I had Sleep Apnea. That is what got me approved. You never know!

HOw do you go about getting that diagnosed? I know my daughter swears that I snore like a freight train!

[GramaLisa 0]

Hi,

The first surgeon I saw kept asking and asking me if I peed when I laughed or coughed. I figured out they were trying to get me to say Yes, as this would be stress incontinence, also caused by being overweight. Maybe that would be a co-morb for you? The first surgeon stopped working on my case. I found out by calling my insurance company. They told me he wasn't responding to letters from them. The first letter asked for a copy of a sleep study. My PCP sent me to a sleep study doctor with a referral in my hand. That would be a co-morb for you if you can get your doctor to refer you. It wasn't so bad, the sleep study. The room was clean and cozy and I rarely saw the other patients there.

I have BCBS FEP PPO through my husband. My BMI is 37.2 but I should be able to get the surgery with that. My out of pocket costs are another matter though, the PA called to set up my first consult with the second doctor I saw and she said my costs are going to run about $4500.00. That's a lot of money to dig up but it will be worth it for me. I just keep gaining weight with no end in sight. I have heard of people, such as one of my bosses, who go into to be weighed and wear ankle bracelets and heavy clothing to make their BMI be acceptable without gaining weight. I have heard of doctors who "remeasure" patients to make them shorter so they have the higher BMI too. I have read of a young woman who after two appeals to her insurance company was told by her doctor to eat something high in sugar right before a fasting blood test. She then tested positive for pre-diabetes and got approved.

My co-morbs are GERD, arthritis and degenerative disk disease in my spine, high cholesterol, high triglyerides, depression, and occasional bouts of anxiety. Xgrl is right, the more you can come up with, the better! Lisa

[skep 9]

Thanks. I got the impression that the insurance specialist at the drs. office was more of a clerk than an expert. To her, the whole procedure was cut and dry. I'm getting some good info here. I think that I took her word as gospel when she stated that the knees were not co-morbidities. all she was interested in was diabetes, high blood pressure, and high cholesteral.

[marzgirl7829 0]

my bmi is not quite high enough either, but i have hypothyroid, herniated lumbar discs and knee pain. my doc said with those factors involved there should not be a problem getting in. i have my first meeting on the 20th of Aug. good luck

[skep 9]

I have numerous problem too but apparently the insurance specialist was only interested in blood pressure, diabetes, or high cholesterol. She had no suggestions as to how to what to do. I am thinking about geting in touch with Viscio Law to see if they can be more proactive in gettting the surgery approved. Woudl it help to call the insurance co.? Would it help to gain the extra wieght to get to a 40 BMI?

[marzgirl7829 0]

i would talk directly to the insurance. the insurance specialist sounds like she does not know jack. i just love how these insurance people who have no medical training try to decide what we need and what we dont. the one time lapband will prevent a whole host of other things in the future, thus actually saving the insurance money in the long run.

[xgrl 0]

Hey,

Your insurance lady sounds like she's only interested in what is outlined by the insurance as what's "co-morbities" I would def talk to someone else about how to get it approved. Perhaps someone that could fight to get it approved because she just doesn't sound like she wants to work to hard.

[skep 9]

I think she was in a big hurry. I am thinking about the Viscio Law firm. I want to get this approved the first time and not have to worry about appeals and such. The worst that could happen is I will have to gain up to the 40 BMI and stay there for a year. That seems really stupid to me but then I'm not an insurance co.