New to Lapband

Hi everyone, Have been reading your posts and journals and am truly excited for you all!!!! I am new to this board and its nice to have people from your own area but more importantly its nice to have such a support group of people who are there for one another and to listen when needed from all over. I am trying to read EVERYTHING I can about the lapband and yet I am very nervous about the lifelong change but I think I want to do it. I am still learning and have had to bookmark some sites and info because it is very overwhelming. I know very little about lapbanding. Although I am just starting my journey I already know I have many obstacle to overcome in order to have to procedure done. For starters I have BCBS of Delaware with an exclusion for any weight related services covered. I was told in another site that I should be able to get around this because its illegal to not provide treatment when I will be seeking treatment for being morbily obese and its more of a health issue. I guess it depends on alot of things but I beleive I fit the criteria to have it done. I plan on calling the insurance tommorow since today is a holiday Any thoughts? or suggestions? I know the insurance is the real problem for alot. My husband works for the local union in DE and the insurance is self paid through the union. Anyone else have this same dilemma? Is so what did you do? Any help or tips would be greatly appreciate it. Am looking forward to get to know you all.

I also have BC/BC of Delaware PPO with an exclusion for any weight related services. I had Diabetes, High Blood Pressure, and High Tryclicerides and Cholestrerol as Co Morbitites with a BMI under 40. I didnt have any problems at all getting Insurance approval for surgery. I am now happy to say as of todays visit to the Diabetic doctor I NO longer take Diabetes medication, have lowered my Blood Pressure, have Normal Blood Work, have lost 33lbs since surgery and have lost 9 inches. In the long run I have saved the Insurance Company thousands of dollars. Good luck with your quest for a healthier you.........

Hi, Congratulations!!!! you must be thrilled!! That is so awesome!! Keep it up Thats a little encouraging. I hope it works out for me. I know there are many different types of plans through BCBS of DElaware. I was looking at my husband health book and it stated it in there. Another board poster made a point that you can have BCBS but your employer can pick a cheaters version of the plan. Some are better than others. Does anyone else work for the local union in Wilm, DE that has tried to get lapband approved? I was told because the union is self insured that I may have to appeal to the union trustees and not the insurance company. Does anyone know if morbid obesity falls under something all together different because of health reasons and not weightloss reasons. Its not like its cosmetic. Its a little confusing so maybe even though its states it in the plan that the employer took out, its possible that the surgery can still be covered by BCBS? It seems a little odd that BC would pay for a surgery that your employer opted not to provide coverage for. Who makes the exception BC or the employer. I know all this has been covered before on these forums but this is still so new for me. I would appreciate any tips or help in this. I have to wait till tommorow to call. Called the doc office today. Was told to leave a message. Called BC - systems were down. Just my luck and I havent even begun!! lol

Hi everyone, I just wante to follow up and tell you what I found out. So it is encouraging for others if they are in the same situation. I called BCBS of Delaware this morning. I was told that my insurance does not cover anything that is diagnosed for obesity. Also, my husband policy at work states what I mentioned above. When I told the rep that my primary doc is suggesting that I have lapband surgery. Thats its not just for weightloss although that would be nice but for health issues she put me on hold for awhile and came back with these conditions. She did say that these are not a guarantee of benifit coverage until my doc calls the referall center and everything has to be precertified even though my insurance does not requirie me to get pre authorized. I guess this case is totally different. She also said that it doesnt say in her list but she does know that get a cardiac clearance and a pshy evaluations is also required. But this is the qualifications that she said: 1. covered if medically necessay 2. attempted and failed at some sort of weightloss for 1 year. She said conservative measure for one year. Does not have to be the past year. (I asked if it had to be for 2005.) 3. have 1 of these: hypertension a BMI of over 35 for more than a year but must be at least 40 now sleep apnea Type II Diabetes Degenerative Joint Disease coronary arteries 100 + overweight I know I have been reading some post that your insurance will tell you one thing and then at the last minute they'll throw someting else in there. They didnt mention about seeing a nutrtitionist for 6 months. So I am actually expecting to hear that needs to be done also. It would be nice to post what some may have had to do before being approved so others can jump ahead. Hope this helps someone. I guess the biggest thing is even though my husbands benefits say no to weight reduction even if recommended by a doctor - that may not always be so cut and dry so its still worth it for anyone to look into. So crossing my fingers..... If anyone knows of something else the insurance has been known to throw in there please let me know. Thanks

Sharon, Welcome to the DE board. Like you, I was a sponge, I read everything I could get my hands (and fingertips) on. I wanted to learn as much as I could about my upcoming surgery. I lurked for a long while before I ever posted. If you are intested in connecting with a dedicated group of people who have had the lap band to learn more about specifics about that particular surgery, OH has a forum for lapanders http://www.obesityhelp.com/forums/LapBand/posts.html If you are searching for specifics about your surgeon, hospital and area, then this is the place. We have so many great folks that hang out around here most williing to offer advice, lend a hand or support, etc. You may want to slip by here as well for someone who may be able to offer you some more advice on insurance issues http://www.obesityhelp.com/forums/insurance-help/posts.html There are also Yahoo groups that specialize in insurance issues, denials, etc ... just do a search of yahoo groups to find them or you can post on the main or insurance board, likely someone will be hanging aroudn with that information at their fingertips. Good to have you here and posting ... I wish you the best finding your answers. Tammy