Newbie and need answers

[jmegirl 2]

From what I gather, nearly every insurance company considers a BMI of 40+ as "qualifying" for surgery. Any lower than that, and you must have at least 2 comorbidities for them to consider you. I'm 5'8 and 250lbs and a 38 BMI, so I know I don't qualify as far as insurance is concerned, which is why I convinced my husband to put us into debt for a few years and self-pay for my surgery! :blushing:

[Kikiphiasmom 44]

OH MY GOSH .. I am having the same dilema. I live in Montebello, not far from pasadena. I have my PCP appt on Sept 10th and am hoping my PCP will refer me to get the lap band. But I'm confussed:huh2: Does Kaiser do lap bands or not? I see from a couple of replays that they are referring one person and not the other. My BMI is 46 I think, so I think I totally qualify. This is really getting me nervous as I so desperatly need this to help with my weight loss. I am tired of all of this YO-YOing .... HELP:blink:

[Boopie 0]

Ok so this is the deal, I had a PCP appt last Thursday @ Kaiser Woodland Hills, I made him send a referral to Health Education (hes cool like that) :blushing:. Anyways so I waited this long holiday weekend and made my calls this morning. I called the Health Education Dept, made sure that they received my referral and had them set me up for labs, Im having that done first thing in the morning, and then they (Hlth Edu Dept) Will call the Panorama City (The Valley) Kaiser and have my orientation set up. Which is 6 looooooonnnnnggggg months!!!!They also said that they do cover Gastric Bypass (Hell To The Naw) Lap Banding, and the Gastric Sleeve. So thats where I am in this long journey, even though they are little bitty baby steps :biggrin: I believe South Bay Kaiser is the other place where classes are held. The bottom line is, Yes Kaiser does cover the Banding, you just gotta stay on them and it will be at least 6 month I guess give or take a few days... Hope this helps Ill give the play by play as I get it

Boopie

[jmegirl 2]

Ok so this is the deal, I had a PCP appt last Thursday @ Kaiser Woodland Hills, I made him send a referral to Health Education (hes cool like that) :biggrin:. Anyways so I waited this long holiday weekend and made my calls this morning. I called the Health Education Dept, made sure that they received my referral and had them set me up for labs, Im having that done first thing in the morning, and then they (Hlth Edu Dept) Will call the Panorama City (The Valley) Kaiser and have my orientation set up. Which is 6 looooooonnnnnggggg months!!!!They also said that they do cover Gastric Bypass (Hell To The Naw) Lap Banding, and the Gastric Sleeve. So thats where I am in this long journey, even though they are little bitty baby steps :thumbup: I believe South Bay Kaiser is the other place where classes are held. The bottom line is, Yes Kaiser does cover the Banding, you just gotta stay on them and it will be at least 6 month I guess give or take a few days... Hope this helps Ill give the play by play as I get it

Boopie

And that my friends is why I decided to be self-pay. :blushing: You make the appointment, and BAM you get your lap band. No doctor supervised diets, no required bloodwork, no required nutritionist meetings or psych evals. Just give them your money and you get banded.

[gabi311b 0]

Yeah she said I don't qualify for the program. She said that Kaiser does offer the lap band through the So.Cal insurance but they just started and you have to go to all those classes. I was so bummed when she said that I didn't even ask what the qualifications were. She gave me all these suggestions like...try overeaters anonymous, food addicts classes, exercise more/eat less. All that bs that I've already tried. She also offered some basic weight management classes that Kaiser offers but again I would have to go to those other locations. I'm so confused, I don't know where to go next. I don't know if I should switch insurances and see if I'm covered or if I should just look into self pay...grrrrrrr

[Boopie 0]

Excuse me, but your PCP is full of sssshhh ut my mouth:blushing:. Anyways what is your BMI cause anything over 40 should qualify you, even with out co-morbs. Change your PCP ASAP!!! Can I ask how tall you are? You gave your weight earlier... Yes Im on the longest journey, but at least Im on it. Yes its like 6 months of classes once a week,, but at least they do cover it. Lord knows I cant afford it outta pocket. But I feel like 6 months of waiting is nothing compared to a life time of being weight challenged (what I like to call it)

Keep your head up Gabs and get a lil persitant. Hell I did, and it worked!!!!

[stripedladybug 0]

I got approved through Aetna but they require BMI of 40 and 3 month supervised diet before they will approve. Sometimes they require 6 month diet if you have no 2 year medical history of issues. Good luck.

[MissBS 3]

Don't even get me started on insurance companies. A few people on here have had a pretty easy time getting approved and banded in a reasonable amount of time, but MOST have to fight and go through what I consider rediculous LONG pre-op diets, testing, etc. They just want to make it so hard that people will either say "forget it" or fail. It makes me sick!!! If your doctor says you need surgery, then you should have it..... not in a year, not in 6 months, and not when some insurance company decides that you are ready for it. I know some people will argue and say that doing the insurance hoop dance is one way to find out if people are really ready and committed to having this procedure done, but I think it is outrageous!!!! Many people have no choice but to do what their insurance provider says, and I do understand that. It just makes me sick what those companies do to the people who keep them in business. Just another way overweight people are discriminated against. If anyone does switch insurance providers because Lap Band surgery is not covered, PLEASE let them know this is why you are leaving - maybe it will help others in the future. YIKES. Maybe I need to take a Midol... just kidding. (it's the pre-op diet.. hehehehe) Just wanted to say what I've been thinking as I read people's posts. Good luck to you all!!!!!!!!!

[gabi311b 0]

I am so sick of Kaiser's s***. I am 5'8'' and my BMI is 38.8. The saddest part is that if I were to gain 20 more pounds I would qualify for the surgery. I HAVE TO GET FATTER TO GET SKINNIER!!! Isn't that unfathomable? I have decided that I am going to switch insurances for sure and then from there see if Aetna will cover with no co-morbidities or I will take out a loan and self pay. I am so frustrated with all the if's and maybe's and we'll see's...I want a definitive answer and I am being so impatient!!! I know I shouldn't be like that but it is so hard when everything I have done has just made me hit walls. It sucks...

AGHHHHHHHHHHHHHHHHH :tt2::cursing::smile2::cursing::thumbup::cursing::smile2::cursing::scared2::bored::scared2::tt2::scared2::tt2:

[Minxz 0]

You might want to change your PCP... I'm Kaiser Nor Cal and I just told my nurse practitioner that i was interested in the lap band she asked about diet and exercise i answered and she set me up immediately for the blood work and sleep apnea test. I already had PCOS so got referred immediately. My BMI has hovered around 40 sometimes dipping below but she did not give me any trouble at all...

Additionally at least up here we don't have to do a 50 week class there are some hoops to traverse and you are looking at a fairly lengthy process but it looks like I should be able to move forward with this hopefully by end of year.

[uaroadtramp 0]

I am interested in getting the Lap Band done and have not even approached my doctor yet. I do have an appointment next week. I am 26 years old, 5'8'' and 245lbs. I have had issues with acid refulx, high blood pressure and borderline diabetes. My BMI currently is about 38. My biggest fear is to get excited about this tool that will be so beneficial to me then come to find out that I don't even qualify for it.

What is the first step when considering this type of surgery? Does anyone have any tips on insurance coverage (I currently have kaiser so.cal and am thinking about switching to Aetna)? Has anyone had this surgery with Aetna insurance? I am also wondering about hospitals, after surgery diet, recovery time, etc.

Any help would be wonderful!

Gabi

Gabi, I will share with you my recent experience. This is not intended to motivate in any direction, it's just a matter of fact regarding myself. I am a 313 lb, 57 year old male who has fought battle after battle with weight my whole life. Even in high school, as a dedicated sports dude, my weight hovered at 200lb on my 5'-8" frame. Of course, as a young man, one can endure many calories as the work outs and activities would easily consume the massive intakes. I will admit I have enjoyed eating. Never a dedicated "junk food" junkie, I've enjoyed all foods. Fortunately, my family has always been very strict with the consumption of fruits and veggies. To this, I am grateful I do not suffer many of the weight related issues others do. I do, however, suffer the genetic condition of osteoarthitis that runs throughout my extended family. The difference is my weight (all of our weights) exacts 6 times body weight force on the knees through out regular activities. That's a whole bunch of weight and force!! My insurance company would rather spend big money on all weight related conditions rather than prevention. It's just the way of the business, I suppose? I decided to take matters in hand via research, knowing this would be a self pay. I chose to have the lap band procedure, and to have it done in Tijuana, Mexico. Now, I know some will freak at the idea of the Mexican experience and there are some considerations to be aware of. My dear cousin (female and same age) and I decided to do this together, one right after the other, even sharing a room. We had a wonderful, caring doctor, our every need was attentive, great support, and was even picked up from and delivered to the San Diego airport upon our release. I've never had any doctor cover any procedure or spend the quality time with us as this doctor. To shorten my long winded story .... I couldn't be more pleased. 3 days post op. Both of us feeling well. Excited about living life. And, so glad to have finally taken action. I will tell you one little drawback for me .... Living in Las Vegas, dry and arid, I used to gulp Water and liquids by the buckets. I'm frustrated by baby sips .... it's just not manly! LOL! food? ... Haven't missed it and I do not experience any hunger as of yet. I hope our experience offers you a degree of further thought. Best of Luck! OBTW 285 lbs WOW! In search for 175 lb. You Go Fat Boy!!!

[Boopie 0]

Gabs with your co-morbs you should be ok, even though your BMI is a lil lower than 40. Is it that your PCP wont give you a referral or is it a different reason? When is your next appt? Is there anyway that you can change your PCP? I promise they do cover the lap band. I have my orientation date for October the 20th @ the Panorama City Kaiser, out here in the Valley. Now mind you, I just went to my PCP doctor 8 days ago and got my referral, then had my labs this past Tuesday, and I called the Bariatric Dept myself, and he gave me my orientation date. I know its like a month and a half away, but at least I do have a date. He also said I can call periodically to see if anybody cancelled in order for me to get into the September class. From what I gather they have only 1 class a month and it seats only 60 people. Hope this helps...

Boopie (your Pasadena friend) :tongue2:

[gabi311b 0]

Does it matter though that I have never been actually 'diagnosed' with co-morbidities? They have never given me prescription drugs for any of them. I can try to switch PCP's (which one do you have)? :tongue2: You can private message me with the name if you want.

Minxz, Unfortunately I used to have Kaiser NorCal and now I wish I never moved! Oh well, this struggle will make me stronger.

Thank you all for all of your support, stories and inspiration! I am truly learning and moving forward because of you all and I can't express how truly apprciative of that I am.

[gabi311b 0]

Gabi, I will share with you my recent experience. This is not intended to motivate in any direction, it's just a matter of fact regarding myself. I am a 313 lb, 57 year old male who has fought battle after battle with weight my whole life. Even in high school, as a dedicated sports dude, my weight hovered at 200lb on my 5'-8" frame. Of course, as a young man, one can endure many calories as the work outs and activities would easily consume the massive intakes. I will admit I have enjoyed eating. Never a dedicated "junk food" junkie, I've enjoyed all foods. Fortunately, my family has always been very strict with the consumption of fruits and veggies. To this, I am grateful I do not suffer many of the weight related issues others do. I do, however, suffer the genetic condition of osteoarthitis that runs throughout my extended family. The difference is my weight (all of our weights) exacts 6 times body weight force on the knees through out regular activities. That's a whole bunch of weight and force!! My insurance company would rather spend big money on all weight related conditions rather than prevention. It's just the way of the business, I suppose? I decided to take matters in hand via research, knowing this would be a self pay. I chose to have the lap band procedure, and to have it done in Tijuana, Mexico. Now, I know some will freak at the idea of the Mexican experience and there are some considerations to be aware of. My dear cousin (female and same age) and I decided to do this together, one right after the other, even sharing a room. We had a wonderful, caring doctor, our every need was attentive, great support, and was even picked up from and delivered to the San Diego airport upon our release. I've never had any doctor cover any procedure or spend the quality time with us as this doctor. To shorten my long winded story .... I couldn't be more pleased. 3 days post op. Both of us feeling well. Excited about living life. And, so glad to have finally taken action. I will tell you one little drawback for me .... Living in Las Vegas, dry and arid, I used to gulp Water and liquids by the buckets. I'm frustrated by baby sips .... it's just not manly! LOL! food? ... Haven't missed it and I do not experience any hunger as of yet. I hope our experience offers you a degree of further thought. Best of Luck! OBTW 285 lbs WOW! In search for 175 lb. You Go Fat Boy!!!

That is a great story! Thank you so much for sharing. The thought of going to Mexico scares me slightly...I've been to Tiajuana (to party when I was younger) and it wasnt' the cleanest of places. I know that is very close-minded for me to say because the hospitals and surgery centers are probably not in the middle of the night scene but it just freaks me out a little. On top of that, where do you go now for fills? I am assuming you don't fly back to TJ all the time.

How long ago did you get banded? 3 days ago?

I appreciate everyone's stories and I have no idea where I will go from here but I HOPE that everything will work out the way it's supposed to and I will be a skinny, sexy chica once this is all over!

[anitat 0]

Gi Gabi I was Banded on July 23rd. I have aetna Insurance ANd I got my approval within a months time But there are some guidlines that they want u to meet if you go to there website & search Baratric Surgery it will give u the guidelines. I had similar problems like u High Blood pressure, Borderline dibetic, Bmi of 38% I followed all the guide lines and had no problems.