I am not 'fat' enough??!!!

suecasb · 10-12-2007, 01:24 PM

Thanks for all the feed back... but I'm not sure I asked the question clearly enough.
It is not a question of gaining it back..I have never lost it. What I need to know is this......has anyone on here ever had a Dr. submit a request for them to have the surgery, been turned down because they did not weigh enough, gain more weight, (11 lb needed.) re-submit and get approved? Same Dr., Same insurance.

suecasb · 10-12-2007, 01:27 PM

gingerbug, had you already submitted a claim and been denied and then gained more weight?

Bullitt2410 · 10-12-2007, 02:05 PM

I vote for the 20lbs. You'll drop it quickly ;) along with more unwanted weight

The 37 BMI not being acceptable is everywhere unless you have a health risk. My mom for that reason cant have it done with me. But she decided just to eat as i did, and not have the surgery, that and she doesnt have time to set aside right now.

lapbaby · 10-13-2007, 09:45 PM

Hi

If this is something you really want I would go for it and gain back just to get started and accepted by a doctor to pursue the LAP-BAND^®
When you start your first stage you are put on a diet regiment anyway , excersize, eating portions, healthy foods etc. that is recorded by a nutritionist. I lost 20 pounds during this period which did lower my BMI but it still didn't affect my qualifications because it was after the initial request for the LAP-BAND^® and it was sent to my insurance before I lost the weight.
I waited several months for approval along with many tests as well. Phsycological eval, blood work, sleep apnea, heart treadmill test, etc. It took quite awhile for everything to come together. I also had to pay $600.00 up front to begin the process which was not covered by my insurance, but I will try to request a reimbursement later which sometimes insurance returns.
Good Luck!

Chris_NJ · 10-13-2007, 09:55 PM

I got a great idea !! At 5'7 and 255 your bmi would be just over 40 ! Just slouch down a slight bit when doing your height and go to the Dr's in the afternoon because you are actually about a 1/4 inch or so shorter by the end of the day. Be shore to have a large meal and drink a lot of water before you go to the DR office. Remember those 16oz bottles of water is a pound on the scale.

ShineNSta · 10-13-2007, 11:09 PM

Quote:

Originally Posted by 100lbsforsale

Ok, help me out here. I am 5'8' and weigh 247 according to the scale at my WW meeting. That gives me a BMI of 37, which is down from a BMI of 40 that I WAS 18 months ago. I have been so frustrated watching my wt go up and down. The stern looks from the WW people when I gain wt again or just lose/gain the same .2 lbs for the 8th week in a row is driving me crazy. So I decided to pursue the LAP-BAND^®. After attending an info mtg, getting stoked from reading this board etc, I talked to my insurance co., got their info (sorta-whole 'nother thread there) but was basically hinted if my BMI wasn't 40 or higher I 'could always gain 20 lbs'..ha ha.... I was appalled. I worked too hard and changed my eating habits to get that 20 lbs off!
I then went about trying to find a doc to supervise my wt loss for the next 6 months. Heres what I got. Screened!!!-:heh: as in screened out by 2 separate doctors becuase 1) my BMI is too low ?37? (oh is that tooo healthy for ya?? 2) I lack a heart condition or diabetes or something thats an easy to pinpoint co-morbidity. Huh? Since when do doctors only take cases that are slam-dunks? Gee I just want to be proactive and STAY ALIVE FOR MY FAMILY and I found out doctors are screening prospective patients because of the kind of care they are seeking.

So my question is this? Should I gain 20+ lbs so I qualify? I can't self pay, but I also can't stand the thought of damaging my body by putting the wt back on!! :hungry: Pancakes with peanut butter here I come??
:help::help::help::help::help::help::help:

Whatever you do, don't gain 20lbs! According to the docs in Australia yes, you have to be over 40BMI to automatically qualify for the surgery. HOWEVER, they do perform the surgery on people who have a BMI of 35+. If you have any medical conditions as a result of your weight (e.g. sleep apnoa, depression, pain etc) , talk to your doctor about them, because those conditions can make a difference in your eligibility for the surgery. If he/she still refuses to recommend you for it then see another doctor because I guarantee there are doctors out there who will perform the surgery on you.

suecasb · 10-14-2007, 01:25 AM

Sorry but I don't think anyone is understanding what I am asking!
I have already jumped through all the hoops....I have had the cardiac and phsyc evaluations and a sleep study. No problems with any of them. I have seen the surgeon..she submitted all the paperwork to the insurance company...the insurance co. turned me down because I am 11 lbs. under their required weight with none of the co-morbids that they require. I am actually surprised that she even submitted it since she knew what my ins.co. required,but it's to late to change that now! I have not lost any weight...in fact I have gained a couple of lbs since I first started trying to get the band.
This is my question..... If I now gain the extra weight.....go back to the surgeon and have the paper work re-submitted...does anyone know if I have a snowballs chance in hell of getting approved???? :cry

WASaBubbleButt · 10-14-2007, 02:24 AM

Quote:

Originally Posted by suecasb

Sorry but I don't think anyone is understanding what I am asking!
I have already jumped through all the hoops....I have had the cardiac and phsyc evaluations and a sleep study. No problems with any of them. I have seen the surgeon..she submitted all the paperwork to the insurance company...the insurance co. turned me down because I am 11 lbs. under their required weight with none of the co-morbids that they require. I am actually surprised that she even submitted it since she knew what my ins.co. required,but it's to late to change that now! I have not lost any weight...in fact I have gained a couple of lbs since I first started trying to get the band.
This is my question..... If I now gain the extra weight.....go back to the surgeon and have the paper work re-submitted...does anyone know if I have a snowballs chance in hell of getting approved???? :cry

I have understood your point from the beginning and I was hoping someone with more knowledge would respond.

The problem is that each insurance company is different. If you are "fat enough" to qualify and then do the six month manditory dieting some insurance co's might say that you no longer qualify and some might not. I don't know which do what.

I don't know the laws about these things. It seems as though if you qualify and the insurance company requires you to lose weight, then you do... it SEEMS like that just can't fly, it would SEEM like that would be something you could fight.

One concern I do have for you is that some insurance co's have an appeal limit. You can only submit appeals so many times and then you are done. Period. You've done it once. What if the next time they don't include some silly paper that is required and you are denied again? You'll have to appeal to submit it correctly. Some insurance co's only give you three strikes and you are out.

BUT! Insurance is not my forte. I don't know what I'm talking about!!! I am only offering what I have read on the various threads here.

I would urge you to PM "Alexandra" and just send her a link to this thread. I doubt she has the time to respond to each and every PM for insurance help but if she reads the thread she might be able to offer some thoughts. She's the best insurance person I know on the forum.

lynlynkr · 05-20-2008, 07:35 PM

It is so unfair

peaches9 · 05-21-2008, 04:11 PM

Lie about your height, gain the 20 lbs... or self pay and just get-r-done...

I took out a loan and took a part time job, because here in Canada we have to self pay... it is not covered by 9 of our Provincial Health Plans.

It really depends on how much you want it...

I looked at it as an investment in my FUTURE health and happiness.

ronwifey · 05-21-2008, 09:08 PM

I gained weight for insurance to approve me. I am 5'6" and had to gain about 10 pounds. The best thing I ever did!

BIG T · 05-23-2008, 03:45 AM

put a big chain around your neck like barney fife did any andy griffith lovers will know what i mean

lapthismargaret · 05-23-2008, 05:03 AM

i know women that put rolls of quarters in there pocket !!!
just athought !!!
i also was trying to gain weight for ins to cover it now i my opting for over time to go to mexico to have it done !!!!!!!!

ErikMesa · 05-23-2008, 05:44 AM

I might've missed it so I'll ask (sorry if it was answered). Do you have any other health issues like sore joints or sleep apnea? I know for me the sleep apnea seemed to be a "big deal" and helped get approval eventually. Have you had a sleep study? Diabetes and heart disease are the obvious ones but sore joints, back pain and sleep apnea are all common problems in the obese.

ErikMesa

sistasassy · 05-23-2008, 10:58 AM

Sue,

I believe that if you gained the weight (or carried the weight or whatever) that you would have a good chance. The only kicker would be if you insurance company were to say that you had to be at that weight for a certain length of time before approval.