I am so upset!!

[cobrien78 0]

I went to get my referral to the bariatric surgeon for the lap band and the dr. was and @$$hole! He said I don't meet the requirements and probably won't have the surgery cause the surgeon won't do it!! I'm soo frustrated for some reason some BMI calculators say my BMI is 38 and some say 36.8!? I'm so upset he was such a jerk! He said I have NO co-morbidities and that my BP which is 133/86 wasn't high because there is a curve they go by to determine whether or not someone has high BP!!

I have PCOS (insulin resistant on metformin), high chol., had gall bladder removed, and I'm 105lbs over ideal weight! Also have Extreme family history of heart disease. I'm only 30lbs away from being 200% over ideal body weight which is an automatic qualifier for tricare. I'm so frustrated, he did give me the referral but kept reiterating how I wouldn't be having the surgery because I didn't meet the guidelines. I see the surgeon for the initial consult on Aug. 26th.

I'm really upset because I just feel hopeless and helpless I've done so much to try and lose all this weight and now if I'm unable I will just get crushed and it won't be long before I will gain that 30lbs and get automatically approved for it. WHY??!!

[wickedme 0]

If he made the referral I would wait to see what the surgeons says before giving up. What is the BMI limit?? here its 30 to 39 with co-morbities, also your insurance has guidlines that they require.. unless you are self pay.. Cholesterol is a comorbity ,, I'm sorry it is so frustrating for you, don't give in and gain that 30 lbs back, you worked to hard to lose it.

[monicasf 0]

Hi, don't give up. I also was told by the general doctor that I would never get approved by the insurance company because my BMI was too low and I had no comorbidities. I cried for a while and then decided I was going to do it anyways and applied for a loan. I got approved in 5 minutes!! I used CareCredit but there are several available. I had my surgery on June 27th and I am down 20lbs!! I will be paying for this surgery for 7 years but I figured I am worth it. Don't give up, you can always go via the self paid option, think of it as an investment, the payments are way less than what you would normally pay for a car or furniture. (My payments will be $190/month).

Don't give up!!!

[ChesterCes 0]

Hey I totally feel ya. In my case I am almost 33 in BMI and all doctors I have called had told me know. I even explain the main reason why since I have problems in my knees and I cannot have normal activities due that the knee does not support the body weight. However, I called one and they say that will do it here in Florida, but their price is too high, they want 17,000 USD, and I cannot afford that amount... So I spoke to one in Mexico they do it for 7,000. But I am a little afraid going to Mexico for surgery, I am looking at Canada and other places to try to make the best decision.. Good luck, do not give up, just Google it and you will find something.

[twistytoo 1]

Cobrien78, Don't you give up! You got the referral and that's what you needed. Hopefully, the surgeon will be more empathetic and help you on the path to better health. Was it your primary care physician that gave you such a hard time? If yes, I would definitely recommend changing to a new Doctor. Someone who realizes that obesity is a disease and food addiction is real. I wish you the best!

[cobrien78 0]

Thank you guys! I actually told the dr. "No offense but, I want the Bariatric surgeon to tell me I don't qualify NOT you!"

Edited July 23, 2008 by cobrien78

[Jillbeme65 1]

I actually work for my pcp and he said that he didn't believe in the lap band that I should just try harder to get the weight off.. He said " I see what you eat". I was like ok well there has to be a different way. I called my insurance and lucky for me they said I didn't have to have a referral I went to a meeting and I was approved with in 8 hrs. They asked for a letter from my pcp. I went back to the office and wrote the letter he said "you know how I feel" I said yes but I know how I feel and he signed the letter. Surgery date August 1st

[Jodi_620 37]

Of course all insurance is different but for insurance purposes, typically you need a BMI above 40 or 35-40 with comorbities. PCOS, Gallbladder removal and family history probably wouldn't be counted as co-morbidities (I have PCOS and a terrible family history and I was told they don't count...gallbladder is not a co-morbidity or even a condition once it is removed). But high cholesterol would be considered a co-mobidity.

But your surgeon might not require you to be within these guidelines in order to get the surgery. If you plan on using insurance, I would make sure I am within their guidelines before I went to any expense...if you are not, they just aren't going to cover it. Otherwise, move forward dispite what this doctor said.

[HeatherO 7]

Before you even meet with the surgeon for the consult, you can check with your insurance today to see what their guidelines are and what they define as a comorbidity. You can basically answer the question for yourself about whether insurance will pay without waiting.

[MacMadame 81]

I agree that the PCP is not the best judge of who is qualified anyway. Many of them are prejudiced against WLS or they are ignorant about it.

If you are close to the weight that your insurance wants, you can work that. Here are some ideas:

-wear ankle weight or put fishing weights in your pocket when you go for the initial consult

-slouch when they measure your height

-wear your heaviest clothes

-drink a bunch of Water and have a meal before you go.

All these things could help put you over the top without having to actually gain weight.

Insurance companies vary as to what they count as a comorbidity. I have high blood pressure but some insurance companies only count that if it can't be controlled by medicine! Also, I think my cholesterol is high but they don't. All my other stuff like plantar faciitis and chronic heartburn don't count AT ALL! It's frustrating to see your weight affecting your health and your life and have it all be in ways the insurance company doesn't count.

[cobrien78 0]

Well according to Tricare I have to be at least 100lbs. overweight and have 2 co-morbidities.

Or have to be 200% your ideal bodyweight.

I am 105lbs overweight and I have high chol. and I have high BP however, noone has ever wanted to treat it except one dr. in the past. See everyone else has said it isn't "THAT HIGH"??!! GRRR! Lots of people in my family have died from heart disease! My own father had a heart attack when he was 28 years old!! I am not even exaggerating! I have PCOS and am insulin resistant. I had my gallbladder removed but crap if I knew it would count as a co-morbidity if I didn't have it removed I wouldn't have!

I just want to have the surgery done and lose the weight BEFORE I get worse! I mean how high does my BP have to get? Do I have to wait to be on insulin too? I'm just so pissed!

I know I haven't been denied yet but when someone tells you these things it's really frustrating.

[obgray 0]

Here are the guidelines from the Tricare manual which govern approval/disapproval of gastric banding.A. Gastric bypass, gastric stapling or gastroplasty, to include vertical bandedgastroplasty is covered when one of the following conditions is met:1. The patient is 100 pounds over the ideal weight for height and bone structure and has one of these associated medical conditions: diabetes mellitus, hypertension, cholecystitis, narcolepsy, Pickwickian syndrome (and other severe respiratory diseases), hypothalamic disorders and severe arthritis of the weight-bearing joints.2. The patient is 200% or more of the ideal weight for height and bone structure. An associated medical condition is not required for this category.3. The patient has had an intestinal bypass or other surgery for obesity and, because of complications, requires a second surgery (a takedown).B. In determining the ideal body weight for morbid obesity using the Metropolitan LifeTable, contractors must apply 100 pounds (or 200%) to both the lower and higher end of theweight range. Payment will be allowed when beneficiaries meet all requirements for morbidobesity surgery including the ideal weight within the newly determined range.I had surgery done on 15 May 08 and it was paid for by Tricare. See the surgeon, and let his staff take it from there. Good luck. It is well worth it.

[terilynn112 1]

Most companies consider Insulin resistance a co morbidity. Mine does.

good luck

Teri

[ChesterCes 0]

OMG... Congrats! please keep me posted with updates, how you feel, what diet they put you on, all the details....

[Jodi_620 37]

It is sounding pretty good for you Carly.

Terilynn, In my experience, Insulin Resistance in the form of PCOS is often considered by the insurance companies to be a fertility issue. When I mentioned PCOS (Insulin Resistance) to my insurance coordinator she said it wouldn't count.

Edited July 23, 2008 by Jodi_620