Question about weight history... ups & downs?

[adagray 1]

I'm just starting to look into possibly getting lapband surgery. I have a current BMI of 36 and have the comorbidity covered since I have had high BP my whole adult life. I also JUST got my first high cholesterol test. Looked at my insurance coverage and one comorbidity (oh what a lovely word?!) is all I need w/BMI of 35 so this should be covered. I have to do the medically supervised diet (Aetna), but that's OK. I don't mind spending some time thinking about this. My mom had this surgery a year ago and I know it is not easy.

OK, so my question is that when they look at weight history, do you think it will hurt my chances of being approved because I have had periods where I lost up to 50 pounds. I can lose it, but the problem is that I'm always hungry and always end up gaining it back. So, my weight histories are something like this...

2003 - 206 lbs (weight before first pregnancy)

2004 - 190ish

2005 - 206 (weight before second pregnancy - I only know this because it freaks me out that I started both pregnancies at the exact same weight)

2006 - 190ish

2007 - 180ish

2008 - 215

My height is 5'5" so my BMI has pretty much been between 30-36 all these years so technically 'obese', but not consistently 35+.

So, I guess my question is are they looking for 5+ years at 35+ or 5+ years being obese?

I know, I know, I gotta check w/my own insurance on this, but just curious what others' experiences have been. Thanks!

[Band_Groupie 3]

After navigating some of my insurance maze (still pre-band) I can reinforce what you said about checking with your insurance directly. It's a simple phone call and you can probably get a print out online or they'll send it to you. I found that even when others had the same insurance co. as mine they widely varied from state to state and in my case even from areas of the same state. I have BC/BS, but specifically Highmark PPO Blue for Western PA, others with BCBS had very different requirements (I don't have to provide any history and others have to provide 3-5 years). If you don't want to call, I'd suggest you repost with the insurance co. name and specific state/area and hope that someone with the same policy would answer your questions (there's also the state by state forum you could try). You're yo-yoing sounds just like me...good luck!:thumbup:

[adagray 1]

After navigating some of my insurance maze (still pre-band) I can reinforce what you said about checking with your insurance directly. It's a simple phone call and you can probably get a print out online or they'll send it to you. I found that even when others had the same insurance co. as mine they widely varied from state to state and in my case even from areas of the same state. I have BC/BS, but specifically Highmark PPO Blue for Western PA, others with BCBS had very different requirements (I don't have to provide any history and others have to provide 3-5 years). If you don't want to call, I'd suggest you repost with the insurance co. name and specific state/area and hope that someone with the same policy would answer your questions (there's also the state by state forum you could try). You're yo-yoing sounds just like me...good luck!:thumbup:

Thanks for your reply. I'm not sure why I am afraid to call my insurance. I just e-mailed them instead. They reply within 24 hours so I guess that will have to be fast enough. My insurance is through Aetna (Choice POS II) and I'm in Phoenix, Arizona. I was able to find some info on various bariatric groups around here and one of the groups said this:

Aetna - covers the band and has worked well with surgeons and policy holders. There are some policies that do not cover the band. For Aetna HMO patients the HMO requires that you obtain a referral in order to see us in consultation..

For other insurance carriers, it specifically said they require a certain # years of history. So, since this wasn't mentioned for Aetna, maybe they don't require it here. Interesting that it varies from state to state and the rqmts are all over the place.

Oh well, I should have more info tomorrow and then can start talking to my PCP for a referral. The sad thing is that if I'm denied, I know I'll EVENTUALLY qualify. I hate to sound so negative, but I've watched my mom deal w/her obesity her entire life and hasn't ever been able to successfully lose and keep off weight until after lapband surgery she had one year ago.