Gaining weight to so insurance will pay for Lap Band

[greytz 4]

Oh, and don't get me started on taxpayers. I have worked hard my entire life and served my country in the military for six of them. I pay my taxes faithfully. I would rather help someone like this than what my taxes actually go for most of the time.

[Marine mom 3]

Never mind everyone. I've decided if denied insurance coverage for it, I will pay out of pocket. I will be on psychotropic drugs until the day I die, if they refuse me on that basis alone, then I guess it wasn't meant to be.

Blessings, Michelle

I'm sorry. I wasn't asking because I thought they should disqualify you. I was just wondering what your doc says about them and the ability to lose weight while on them. As I said when I was on steroids, there was nothing that could have kept me from eating. I would have just cheated. It was such a desperate need to eat. I know a couple of bipolar meds cause some of the same issues. I saw a child gain 40 lbs. in 2 months when placed on a particular med.

[june09bandit 0]

Good luck Mond - only your health care provider can decide what is right for you. Everything we say on this board is strictly our own opinion. I still don't know what the psych consult was to prove/disprove, so I can't offer any words of wisdom regarding what it likely to disqualify you. I just answered all the questions honestly and hoped for the best.

Unfortunately, your post came at a time of serious political unrest in the US and I think a lot of board members took out their frustrations on you without hearing your history - and yes, I do think your history makes a difference.

I know I too get frustrated at those that abuse our system and have more babies to get more of our tax dollars - and yes, I am sure that some do that as a motive because they've admitted this to me. With all the political talk of revamping our medical system, everyone is a bit touchy because it will impact all of us in some way.

Does Australia not have the people that abuse the system, or does your government have a way to control that? That's an honest question.. never been to Australia, but I'd love to go!

Edited December 17, 2009 by june09bandit
because I left out a word

[Erin Marie 0]

Dude you don't weigh enough. Case closed.stop using our tax money for a surgery that isn't 100 percent needed. If it was they woulda approved you. Odd that your told no then low and behold you go back weighing more?? Come on.

Actually, according to my doctor and the surgeon, I needed the Lapband. And yet, for whatever reason, my insurance denied me for six months. The Center had to call in an attorney to tell them that "YES, it is medically necessary."

Just like some people might say she doesn't weight enough some people were saying I was too young. But why should I wait till I'm thirty to get a procedure that would help me NOW?

What I mean is... sometimes even those that really need it, even they don't get it right away, if at all. (I was 5'5" and 290 pounds when I submitted my first insurance packet. At a BMI of over 48 they turned me down, hard and flat).

[TSB 1]

What a heated debate! As far as the whole is your BMI high enough and/or are your health problems serious enough . . . . that is a determination that should be made between a doctor and their patient. When my pcp made the referral my BMI was between 38 & 39. On the day of my surgery my BMI was between 35 & 36. My only real health issue was high cholesterol for which I was taking medication.

I get the whole issue of taxpayer resentment. I work in a social service field. While I do not directly work in entitlement programs such a Medicare, TANF, food Stamps...the program I work in deals a lot with the same clientele and with the eligibility workers. So, I see first hand some clients who really would do anything within their power to avoid personal responsiblity in all areas of their lives. But I see far many more people who really need help to get through a tough time.

When I was young mother I also had the personal experience of having had to rely on public assistance to provide for my children.....it was a degrading position to be in. So, having "been there" and having worked my @ss off to make a better life for my kiddos.........I try really hard not to judge.

If an investment in WLS by medicare now will prevent a life time of spending on the various chronic ailments that accompany obesity, I am all for it. Perhaps resolving this person's obesity and related health problems will enable her to become a productive member of society.

Edited December 17, 2009 by TSB

[alicez 0]

Medically necessary for a patient: Patient's weight which should be 100 pounds or more above ideal weight or a BMI more than 40 or more than 35 with associated medical problems to qualify. Your BMI is OK just find individual insurance companies, like First Health, United Healthcare, Cigna, Great West or Blue Cross Blue Shield Federal.

[Jachut 487]

Does Australia not have the people that abuse the system, or does your government have a way to control that? That's an honest question.. never been to Australia, but I'd love to go!

Oh, of course we do. However our system works a bit differently in that everyone, regardless of income is entirled to medicare coverage and then private insurance picks up the gap over that, to put it very simply, if not entirely accurately.

So even though there's been all this news about the band being covered by medicare in australia, its just that most doctors dont operate in the public system, in public hospitals, but operate privately. But medicare will always pick up most of the bill.

I've even had a rant or two on it myself, although usually its about stuff like childcare benefits and family assistance. Plenty of people abuse that system, my particular beef is tradies such as plumbers and electricians who work for cash and then reap all the assistance without declaring that they actually have income. That's the "australian way" mate! Grrrr.

[HappyHomeCC 2]

Thank you to all who have been helpful and supportive. And for the final record, I don't plan on scamming anyone. I've decided to give it my best shot; if I happen to gain weight between my first appt. and now, then so be it. I'm going as-is and if insurance won't approve me, I will research ways to pay for it on my own. I firmly believe in "where there's a will, there's a way" and I will find it somewhere! :-)

Blessings, Michelle

I admire your Michelle. You are very candid and willing to fight for your self. hang in there and do the best you can.

[HappyHomeCC 2]

Jacqui, I haven't told you yet ... been reading your posts for gosh... months... Love them... thanks!

[XxMariposaxX 1]

Wear ankle weights, heavy jeans and boots to your consult. It helped me "gain" 14Lbs. :tongue:

[Marine mom 3]

because lying is always the best answer.

[Cocoabean 430]

I don't know about Medicare, but some insurance companies are now requiring a history of a BMI above a certain level for a period of time to qualify.

So gaining weight for the purpose of qualifying for surgery "benefits" might be a longer process than expected.

I have read some posts of requirements of 2-3 years' worth of proof.

Denise

[Excited4Change 0]

I haven't read through the whole thread yet. However, when I first became interested in the lapband was sometime in the summer of '08 I believe. I went to a seminar and I knew that this surgery would be the right thing for me, I was at a weight of about 220lbs. Unfortunately I got a call a few weeks later saying that I did not weigh enough for the surgery. I was devastated. That fall I went off to college and instead of gaining the freshman 15 I ended the year after putting on a freshman 30 yikes! I didn't purposely gain that much weight but it happened, and now thankfully I do qualify and am getting the lapband this Friday. I am not judging anyone who is under 200lbs or even just over 200lbs because honestly I am jealous that you guys are somehow eligible for the lapband at 220 or lower when I wasn't (I'm sure height and BMI plays a part, as well as co-morbidities, I am 5'5 no Co-morbidities)! The lowest weight I can ever remember being is 194 and that was probably in 6th or 7th grade. I wish I could have gotten the lapband then or even when I was 220lbs instead of having to gain 30 lbs to be eligble. Now I just have more to lose and will take a while longer to reach my goal weight. So I guess my point is, I'm sure most of us wish we could have found this wonderful tool earlier in our weight loss struggles, and while we may not agree with someone under a certain weight getting the band, whether that be because we are concerned or even jealous, I am going to assume that their doctor knows what is best and would not allow someone to get the band if they truely do not need it. I am also not going to pass judgement on anyone, especially if I don't know all of the facts. They could have other conditions or there may be other things that I don't know about that give them more reason to have the surgery.

Anyway, I'm sure this post just sounds like a big ramble but hopefully it made a bit of sense. (I am on my liquid diet and a bit tired so I am sure that is where the rambling is coming from!)

[Manda87 3]

This whole thread makes me sad. I'm 330 pounds, and I would LOVE to be in the 180s. However, what got me to 330 pounds was McDonalds, coke, chocolate, and candy. McDonalds is the worse. BigMacs are amazing, but have more that 1000 calories in each. I used to have 2 McChickens, 1 BigMac, 1 medium fries, and 1 large coke or iced tea all at one time. Yeaaaahhhh.... it's not fun to be a 330 twenty-two year old girl. I envy you those that are weighing in the 200s. It's my fault I got this way, so I'm paying the price - the price for my health and the price for the surgery. Good luck, and I hope you get the surgery.

[Chele6378 0]

Wow! 184 is lower than my lowest weight in the past 10 years!

I busted my ass to get where I am! And I'm not talking about getting the scale high enough. I mean I went to the doctor. I followed up. I took every step they told me too and crossed every 'T' and dotted every 'I'. I worked with what I had!!

I'm heavy enough but I still had to do the work my insurance company required. If you're not heavy enough, take that as a blessing and focus on something else to make yourself healthier. Maybe therapy and changing medications is the answer?

I wish you good health and success in the future.