New and the fighting process begins

frauhowe · July 8, 2009

Hi everyone, I’m new and just wanted to introduce myself. My name is Laura and I’ve recently reached my decision to have surgery if I can get approved for it. The thought has been in the back of my mind for about a year, but for the past couple months I’ve become serious about it and have started reading books and doing the research, which is how I discovered this forum. I haven’t yet decided which method is better for me (banding vs bypass), there are inspiring pros and terrifying cons to both, so at this time I’m still researching both and am hoping to learn about peoples’ experiences and/or regrets about both procedures. At this point I think I’m leaning more towards banding.

I have Blue Cross of MN and since they require me to have a 6 month medically supervised diet program, I figure there’s no sense in even making an appointment to talk to a surgeon until I’ve gotten that behind me, but am I the only one that feels this requirement is ridiculous? I can understand why they do it, but do they really think if dieting worked so many people would need to be considering something as serious as surgery? My BMI is 42.2 and I can just see it now….sure I’ll be able to get 30 or so pounds off in 6 months, but then I’ll be below the required 40 BMI. And then I know what’s next…”sorry you no longer qualify…please continue on your current successful weight loss plan.” (newsflash it’s not successful if it’s temporary!!) Anyone can lose weight on their own, but how many are able to keep it off? Very few, and even the insurance companies know it. Statistics say that the heavier a person is, the more likely they are to regain their weight. That’s what’s so discouraging, is knowing that I have to lose some, but if I lose too much I’ll be disqualified and then chances are the weight will come back anyway. Every time I try doing it on my own I only end up making it worse for myself (lose 5, put back 10, etc.)

And then if I do put it back on before applying for approval I’m afraid I’ll get accused of intentionally sabotaging myself just to get the surgery and get denied because of that (do they really think that way or am I just being paranoid?)

I’m not currently taking any medications so the insurance co doesn’t see me as a high financial risk yet. I’ve felt fine physically until this past year, when I really started feeling my weight. My feet and knees always hurt because I have plantar fasciitis and chondromalatia (neither of which are on the co-morbidity list). I don’t currently have diabetes, but it’s everywhere in my family on my mother’s side, so my getting it eventually is pretty much a no-brainer. My mother has sleep apnea – I don’t know if I do but I’m told I snore pretty badly (bad enough for my husband to wear earplugs to bed every night). I don’t know if I just make a lot of noise or if I actually stop breathing, I don’t wake up during the night that I can recall, but I usually do wake up feeling tired in the morning.

Has anyone else teetering close to the magic BMI number had a problem getting coverage because of this?

ParrotheadCathy · July 8, 2009

Laura, go ahead and go to the surgeon you choose. Most of them can do the medically supervised diet with you and during that time get your testing done and out of the way. They will put together the application for approval to your insurance company and submit it as soon as you've finished the diet. That way, you've streamlined the process! The surgeon's office can help you meet the requirement of the diet plan but still be qualified for insurance approval for your surgery.

It does sound like you may very well have sleep apnea. You will likely have to have a sleep study done as part of your pre-op testing. Best to get that out of the way because the CPAP machine will help you be more rested when you wake up in the morning! Thankfully, that was one problem I didn't have but it is a comorbidity that many overweight people suffer and don't even know about!