Hi - What are my chances?

Mrs Sabre · 09-02-2005, 12:18 PM

Let me first say that I love this site so far! I've already found a ton of useful and interesting information.

After reading everything I could find on Lap-Band® surgery, I went to my internist to see if he would recommend it for me. He's completely supportive and is willing to fight with my insurance if need be to have it covered. (It is covered under my health care plan.)

My BMI is 37; I'm 5'6" and 230 lbs. My co-morbidities are all boarderline, i.e. boarderline high blood pressure, chronic heart burn (maybe unconfirmed GERD), insuline resistance, sleep disorder (restless leg syndrome w/ periodic limb movement disorder) with snoring, and chronic depression. I'm also hypothyroid, status post radioactive iodine treatment for Grave's disease.

From your experiences, does it sound probable that I'll be covered by my insurance?

La_madam · 09-02-2005, 12:22 PM

What insurance do you have?

Mrs Sabre · 09-02-2005, 12:36 PM

I have United Health Care thru my employer.

I'llsucceed · 09-02-2005, 12:45 PM

I am sorry to say that it doesn't. I was 38 5'6"240pds W/co-morbidities like yours. I actually gained some weight to help it be approved & it still wasn't & I was than heavier! Don't do that!! BUT that doesn't mean it won't come through! All insurance companies are different. So you should try & if you have to fight like hell to get covered. After nealy 9 months I decided to be self-pay. I wish you luck & hope you DO GET COVERED! I didn't have high blood pressure so hopefully that will work for you. Also when I switched Doctors I would slough when I was measured for my height just so that would help too- now they say I am 5' 5"-LOL LOL

La_madam · 09-02-2005, 02:51 PM

Untied Health Care does cover the band..I know this for sure. Whether they cover you with such a low BMI is another story but it is worth a shot. I had a friend who just recently was banded here in CA and had United Health Care but she did have co-morbitities and a higher BMI, Give it a shot, you wont know until you try. Good Luck :)

Jessiebear · 09-02-2005, 07:31 PM

Welcome! I wish you luck with your insurance! I say FIGHT! Also find out if the company you work for chose an opt out clause for any kind of obesity surgery. That was my case! We had United Healthcare at the time. Good Luck!

sandie1958 · 09-04-2005, 02:13 AM

karen , i have united health care work for bellsourth . they cover WLS my bmi was 35.3 i had no problem also a friend of mine on thissite had united health care her bmi was low i think around 31 the insurance paid for it so go for it . you can call uhc & see if your plan covers wls . good luck best thing i have ever done for myself. sandie

Mrs Sabre · 09-06-2005, 11:26 AM

Thank you all for the input. My coverage is through Wachovia Bank, and I have already confirmed that they cover WLS. I just wasn't sure about coverage for lower BMI's & boarderline co-morbidities.

I saw my PCP on Wed., 8/31/05, and he mailed my predetermination letter on Fri., 9/2/05. To extend the paper trail and increase my chances, I see a weight loss/bariatric specialist on Thurs., 9/8/05.

The ball is rolling; I just pray UHC agrees!

gordonfamily3 · 09-07-2005, 10:42 AM

Hey Karen,

I to work with Wachovia and I have had the band and I have UHC also. They do cover it. I had NO PROBLEMS at all. (I have talked with you on the NC board some.) I paid $100.00 which was my co-pay for the hospital and that is it. Actually it took them only 3 short days to approve mine. You should be fine....most Dr's will ask you to go through a series of test and my surgeon writes a letter to go with every package to the insurance company. Personally I think you will be good to go....

Again welcome....and good luck!!!!

Haygal · 09-07-2005, 11:16 AM

I also have UHC. They approved me quickly with no problem. Good luck...Haygal

Banded on 8/15/05
lost 20 lbs

CCBSTX · 09-07-2005, 12:15 PM

I also have United Healthcare and was approved in 4 weeks. I am also 5'6" and was 260 pounds. I have to admit that I ate my way to 260 from 251 (no problem)!!! I have no comorbid conditions.

From what I gather is either UHC and your company has exclusion against weight loss surgery or it doesn't. Give them a call and ask a general question.

Good luck.

Mrs Sabre · 09-07-2005, 01:29 PM

Kim, how long did it take from start to surgery for you?

OK, now I'm excited! From those who have UHC and work at Wachovia, it doesn't sound like I'll have any problems. Now I just have to wait for the OK. Yippee!

gordonfamily3 · 09-07-2005, 04:06 PM

Ok well I will tell it took 6 months but I ran into some problems. Not with the surgeon with some other test getting them scheduled and etc. If I wouldn't have had any problems it would have taken @ 3 months, which I don't think is that bad. (from the time I turned in the packet to surgery date). Please feel free to email me or PM here if there is anything I can answer for you.

Mrs Sabre · 09-07-2005, 04:18 PM

Kim -

I've sent an e-mail. I don't know how effective it is through this site, but we'll find out.

Danistar · 09-08-2005, 10:32 PM

Hi

I just wanted to share with you that restless legs and snoring are a sign of Sleep Apnea, which is a common problem with obesity.
If I were you I would check this out. I have Sleep Apnea and feel so much better now that I have the proper treatment, which is using a CPAP machine at night.
Dani