Pull up a chair, maybe a pillow too!

[tennleslie1 0]

Greetings from Knoxville, TN!!

I'm never really sure what to put about me in the sections of forums that ask "about me". Let's start from the beginning. I'm 30 yrs old, I will turn 31 on February 1. I have been married to my high school sweet heart for 10 yrs this past June. We live in Knoxville and have 0 children.

In 1997 I was diagnosed with Type 2 diabetes. I should have seen it coming considering my mom had it and now my dad has since been diagnosed with it. Luckily, they are able to control theirs. All of my life I was (and still am) the "pretty, lil' chubby girl". That was okay until I learned it wasn't that great of a compliment.

I have been looking at the lap band for a few years now, but only found out recently that our insurance now covers it (they hadn't in the past because the procedure is reversable). Having found out otherwise I am now thrilled with the possibility of having the surgery and becoming healthy. Like I said, I am 30 yrs old and have a BMI of 34.9 I am tired of being unhealthy. I want to start living my life and I want to do it by feeling healthy.

Jan. 13, my husband and I will attend a seminar given by a Dr. here in town who will discuss the pros/cons of the surgery and how to "get the ball rolling" so to speak. I have no idea what to expect or even where to begin. If anyone could suggest a Dr. that they know of in this area I would greatly appreciate it. Like I said, I have no idea where to begin so I checked out one of the hospitals here and found his name. He is the head of Bariatric Surgery but in this day and time, titles do not necessarily mean anything. Any help you guys could offer would be much appreciated.

[LuvMySteelers 0]

If you can't find someone you like in Knoxville, I can give a great recommendation for Nashville. Remember, you will develop a close relationship with your surgeon for years following surgery, make sure its someone you feel comfortable with! If the seminar is good, you will get all the information you need to start the process. If you leave feeling confused, I would be skeptical of their center.

Thats just some advice from another "pretty, chubby girl!" :thumbup:

[Band_Groupie 3]

Good luck to you! I'd strongly suggest you find out the insurance requirements before you attend your seminar/start diet requirements. Your 34.9 BMI was a HUGE red flag to me as I was there too. Read my beginning posts/blogs to see how I set myself back 2 months by being 1 pound under the 35 minimum BMI required. Here's my "I Peed My Pants" blog from the day I RESTARTED the diet...ahhh, memories...good times...have yourself a laugh...

http://www.lapbandtalk.com/blogs/51088/blog7550.html

[tennleslie1 0]

Thank you both so much. Do you guys happen to know if BMI differs from insurance to insurance or is it the same straight across the line? Honestly, I'm afraid of getting my hopes up. I'm running out of options.......and hope. Thanks.

[LuvMySteelers 0]

I have Blue Cross Blue Shield Federal Employee Program - I did not have to do the 6 month diet. I only had to have the letter of recommendation from PCP and do a Psych test...BUT my BMI had to be 40 or above. I was teetering on the 38-39 line. Like BandGroupie, I ate a huge meal and downed LOTS of Water right before my weigh in! I would call your insurance and ask a general question - what is your bmi requirement for lap band? Don't tell them your current step in the process, you're just beginning to think about it! They should just be able to give you a straight bmi number and end of conversation...that way you'll know where you stand!

[tennleslie1 0]

Hmmm.... sounds simple enough. Me thinks that shall be numero uno tomorrow morning! Thanks Steelers!! Seems like somewhere I read something about BMI being 32, someplace else it was 35 and like you, I also read 40. Do certain comorbs play a part in it? I'm Type 2 Diabetes, I have been for going on 11 yrs, high blood pressure, family history of heart disease and myself I have A-fib. Just wondering... you guys are absolute jewels for answering my questions, thanks so much!!!

[LuvMySteelers 0]

I'm assuming my approval was so easy because of my Federal Gov't Insurance. My BMI had to be 40, and that was pretty much it. I had no co-morbidities. I did have a family history of heart disease and cancer, but thats about it. But I do know that with most insurance agencies, having at least one co-morbidity is a big step towards approval (high blood pressure & diabetes are 2 huge ones!) Good luck with your approval process!

[Band_Groupie 3]

I've never heard on LBT of anything other than needing a 40 BMI or a 35 BMI with comorbidity (varying amounts of comorbidities/requirements needed). Now after that, insurances differ a lot, like the diet or diet history, or long term BMI documentation, etc. I'd be shocked if you don't need at least a 35 BMI (better to start a little higher like I did and as long as you've got documentation from your PCP and have been on meds then you've got the comorbidities needed (diabetes and hypertension are two of the 5 biggies they look for). Call and ask the insurance person how to access the Bariatric section of your particular policy online (I think all insurance co. now have this online), that way you can print it out and take it with you to your seminar and it gives you something to develop questions from for calling the ins. person back.

[tennleslie1 0]

I called our insurance last week and asked if they could send me some information about the surgery. Here is part of the letter that I received. It didn't, however, mention anything about a BMI so, I'm lost...

***********************

In order to complete our review if benefits are available, we need additional information. Please refer to the list below and provde us wtht he items indicated so that we can complete our review.

* History & Physical including Height, weight with co-morbidities

*Initial Evaluation

*Documented 5 years History of Morbid Obesity

*Documented failure of 6 months of medically supervised non-surgical methods of weight reduction by either MD, DO, Nurse Practioner which includes nutrition therapy, behavior modifying exercise or increase in activity, medication therapy or mantenance therapy

*Psychological Evaluation

*Documentation of willingness to comply with the pre operative and post operative treatment plans

*Documentation of Procedures to be performed along with codes

*Is procedure being done short/long limb and how many centimenters and length.

After receiving this information, we will conduct an additional review to determine if benefits are available.

Sincerely,

Customer Advocate

************************

So, who knows.....I know that nothing worth doing happens all that easily, so I'll just continue saying my prayers each day. Surly God hears a good ole' country girl in Tennessee!!

[Band_Groupie 3]

Good attitude! Even though they don't mention the BMI in their list of things for you to turn in, trust me they have minimums. Just call and ask. Good luck on your 'quest'!

[Tabithan 19]

I had United Healthcare with my company. UHC's requirements at the time were a BMI of 40 Minimum (without co-morbidities) or a BMI of 35 with Comorbidities. I had no Co-morbidities but my BMI was right at 40 so it was a breeze approval. From everything I have seen, different policies have different requirements, but a Minimum BMI seems to be in everything I have seen.

Good LUCK!!!!!!!!!

[kpdgal 0]

Hi Guys,

Im from Knoxville too... I am going through Dr. Mancini at UT Hospital. I have CIGNA insurance. You should be able to go to your insurance carriers website and look at pre-req's for the surgery. Most with lower BMI's require a seconday factor like high BP, sleep apnea, diabetes, etc. I found Lynn Moreland the PA there to be very helpful in the process and they make sure that everything is done and qualified before you spend your own money..I was going to Dr. Boyce, but he had a $3,000 requirment for "follow-up" etc, where Dr. Mancini only required $578 out of pocket. Their staff is great though, Several ladies at my office have been through the procedure already!

GOOD LUCK 2 YA!

[tennleslie1 0]

Hey Stephany,

After much research and talking with folks, I have narrowed down my choice for surgeons (if insurance will approve me). Feb. 2, I see Lynn Moreland of Dr. Mancini's group at UT and then on the 6th, I'm going to head over and see what Dr. Ray at Blount Mem. has to say. I really think that I'm going to like Dr. Mancini from what I've heard. Is his office staff pretty good about helping you get your insurance approval?

Best of Luck to ya!!

[kpdgal 0]

They do contact your insurance company for approval guidelines and make sure they are followed to the exact letter. Noone from my office has been denied. All insurance companies are so drastically different on what is and is not covered and it really depends on your employer and what coverage they are willing to pay for. I have been at 911 for 10years under cigna and this is the 1st year they have actually covered bariatric! To answer your question though, Lynn is very knowledgeable about the process and will find all your answers. They are all very sweet there and I look forward to every appt... My insurance requires 6months medically supervised "weight monitoring" which Lynn is in charge of, so they won't actually send in for approval until I hit my 6month mark. I am confident that I will be approved though. Good luck and lets keep in touch!

Edited January 25, 2009 by kpdgal
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