Help!!!! need answers...

[jolainajo 0]

Hi everyone, first off I have been on this weight loss game for way too long. I have had it and decided to go see my dr about the lap band. I weigh 220 am 5'5 almost 5'6 and apparently qualify for lap band. I have health plus ppo and am sched to have my psycological done on june 15, meet with bariatric center surgeon on june 18. Do you all think I qualify, my insurance does need a 1yr of weightloss efforts by my dr. in which I do have, she put me on adipex, went to ww. tried on my own. Does anyone have this insurance?? Do I need to gain more weight to get qualified?? I feel sooooo yucky now, my clothes dont fit, summers coming and the cellulite on my legs and arms are driving me up a wall.. I did the whole working out at the gym for 2 hours, had a personal trainer... I AM SICK OF IT ALL!!!!!! Now im scared they are going to tell me I dont qualify.... Please someone help..... Thanks... Jo

[ParrotheadCathy 0]

Doesn't matter if we think you qualify. Call your insurance company (there should be a customer service number on your insurance card). Give them your policy number and ask them (1) does the policy cover weight loss surgery? (2) If yes, what are their specific requirements so that they will approve the surgery.

[pennreporter 12]

I haven't been banded yet but I've gone through what you're going through. Like previous poster, find out EXACTLY what the requirements are, because many many companies require a 40 BMI. I'm 5-4, highest weight was 235, but I didn't meet the 40 BMI that my ins. co. required. For 35-40 BMI you had to have several comorbidities (BP, cholesterol) but most importantly I had to be diabetic or have sleep apnea and require a CPAP machine. My primary doctor was extremely supportive and even suggested putting rolls of quarters in my pockets to be even heavier, sent me for the sleep study, which evidently didn't surprise any of my family members that my snoring rose to the level of sleep apnea (thanks guys).

So you should be able to get exactly what your company requires. And be very specific about the BMI

Good luck

Trisha

[HeatherO 7]

pennreporter is correct, unless there are comorbidities you probably need a BMI of 40. At 5'5 and 220 your BMI is 36.6. You wouldn't hit the BMI of 40 range until you reached 241 pounds.

Checking with the insurance company is the best way to go. Also there is a difference in qualifying for surgery and getting the insurance company to pay for it.