Lap Band Not Covered???

[Alexandra 55]

Kat, according to the AMA, the FDA, and the medical communite at large, being so overweight that one's BMI is 40 or above IS a health problem all by itself. That's why that's a magic number. I didn't have any health problems (co-morbidities) either, but my BMI was 47 and that's all they needed to know.

[DrHekier 0]

Kat, according to the AMA, the FDA, and the medical communite at large, being so overweight that one's BMI is 40 or above IS a health problem all by itself. That's why that's a magic number. I didn't have any health problems (co-morbidities) either, but my BMI was 47 and that's all they needed to know.

A BMI of 30 is the level considered "obese" and per the National Institutes of Health (NIH) places an individual at high risk for Type 2 diabetes, hypertension, and coronary artery disease. Additionally per the NIH it increases the risk of stroke; gallbladder disease; osteoarthritis; sleep apnea and respiratory problems; and endometrial, breast, prostate, and colon cancers.

However, most if not all insurance companies follow the guidelines set forth by the NIH in a consensus statement in 1991. In that statement they set forth that potential candidates for surgery have a BMI over 40, or over 35 with comorbidities. At the time of this consensus statement in 1991, the two main bariatric surgical procedures were open Roux en Y gastric bypass, and the open vertical banded gastroplasty (VBG). Those open procedures certainly have more side effects than the Lap Band. Also there was certainly less literature and scientific study available with results from bariatric surgery in 1991 than there is today.

I would not be surprised if in a few years, as the scientific community is made more aware of the benefits of the Lap Band, when compared to other bariatric surgical procedures which have higher risk, we will see the "bar" for surgical intervention drop from BMI of 35 to BMI of 30 from the NIH.

[Alexandra 55]

Dr. Hekier, do you think the "bar" for surgical intervention should be the same for all the various procedures? If it's essentially a risk/benefit analysis, I think the bar should be very different depending on the procedure, because the risks are so vastly different.

[kat72 0]

Alex and Dr.Hekier, thanx a bunch for the info. The only reason I asked the question is because I read one of the threads on this web-site, and someone mentioned that although they were overweight with a high BMI, they were not covered by for the band because they had no health problems, just "a healthy fat girl". It made no sense to me, so I thought I'd try to get a bit more info. on it.

[DrHekier 0]

Dr. Hekier, do you think the "bar" for surgical intervention should be the same for all the various procedures? If it's essentially a risk/benefit analysis, I think the bar should be very different depending on the procedure, because the risks are so vastly different.

That may sound like a sensible thing to do, but would add a layer of complexity to an already complex and not necessarily sensible system.