Lap Band Surgery Questions

I am trying to make decisiosn about having lap band surgery. I am 35 6'1 269 pounds. BMI of 37 to 38, have high blood pressure, high cholesterol, and diabetes all controlled by meds. I have tried exercise programs with diet unsuccessfully most of my life. Most recent was the Atkins diet for 6 months. Lost 40 pounds and gained 60 back. Then I bought a whole in home gym treadmill, stationary bike, weights. I made it a regular thing to exercise 45 minutes every day. Two things happened. I got worn out and sick from trying to balance that school, kids and house work. This happens every time I get to the point where my body is stressed and have to stop. I am always hungry with the exception of being sick to my stomach from diabetes medicine.  I have a good diet lots of fruits and moderate vegetables, limited if any sweets.  I have two concerns. First can anyone tell me how BCBS of Florida State PPO handles the coverage for surgery? I read in the manual that it is suppose to be included only f medically necessary. What do they consider medically necessary? What hoops do they require to jump through? 

 

 

 

 

Second concern: We basically decide to have this surgery to improve our health and improve our self esteem. Well I am personally disgusted every time I take my clothes off and see all this fat and stretch marks. I know it would help my health immensely to loose weight and this would be a good way to help me make permanent life changes. However, I am worried about excess skin after weight loss. I have had drastic weight loss 40 pounds over 6 months with no excess skin. But if the weight loss causes excess skin I am worried that this will be just as bad for my self esteem as being fat. I want to be able to be proud of who I am when I am undressed. I don’t’ want to go from being disgusted by fat to being disgusted by excess skin. All websites suggest various plastic surgery procedures two years after. This is not something that I would ever be able to afford. So can someone please share their experiences with me? I need to loose about 90 pounds to be in line.

Brad, first let's talk about the BCBS of Florida - Have you've call BCBS directly and asked about them covering you?  Even if it states it in the Manuel you have saying it's covered it may not. Have you've gone to a Surgeon Seminar about the Lap Banding, that you have thought about using. A Surgeon's office has a direct link to these Insurance companies with a much closer relationship then the Insurance Companies own clients. Now as to losing or staying Fat. Or losing but having hanging loose skin. I'd rather have the disgusting skin which I could & will live with. As my losing the extra weight has extended my personal life now by many years. I'm 51, my Mom died at 59 & Dad at 62 the same as his Dad.By losing the Extra Poundage we may have a chance of living further than everyone expected. There ARE a few Plastic Surgeon's in Florida that do take Insurance. These Doctors will actually fight to have the Insurance carriers IF our extra hanging skin is a Health Hazard and needs to be removed if Medically Nessacary, Pay for it!. Document everything as Rashes, Pains, etc. related to your weight loss. Please keep us posted of your progress? OH and where are you? Mike

Welcome,  Brad.  I do know how you feel.  I have alot of the same issues with trying and failing to keep weight off long term, and having trouble restarting.  It's not unusal actually, and I would guess it's the reason many of us got here.  The research is starting to show that this phenomenon is not necessarily attibutable to a lack of willpower, but is a biological/evolutionary response to chronic dieting (or meal skipping), and it's tough to combat without help.  Enter WLS, which seems to be one of, if not THE, most effective tools to reverse this cycle.   As for your first concern, with your co-morbidities you may have success having surgery covered by BCBS.  I don't have experience with them personally, but unless you have a specific exclusion from your policy, you may be in luck!  They may require some additional steps (i.e. a supervised weight loss plan, documenting prior weight loss attempts), but it will get you covered in the long run. As for your second concern, your skin's response is based on how much weight you have to lose, how quickly you lose it, your age, and genetics.  It's impossible to predict with any degree of certainty what any one person will experience.  With only 69 pounds to lose, however, I find it hard to believe that you will have much skin to be disgusted about.  A little sag in the stomach is better than a beach ball belly (at least that's what I'm telling myself--LOL).    It sounds like your weight has done a number on your self- esteem (or vice versa).  Try, if you can, to re-direct your focus from having the perfect looking body to improving your weight-related health issues and having a perfect functioning body.   If you take care of yourself (mind and body), the cosmetic stuff will follow. Best of luck to you in your journay.  Be kind to yourself.

Jen,  Thanks so much for you kind words and advice. This is a journey that I am just now beginning. I have been thinking about the surgery for about a year now and am just finally to the point with my health that I am working with doctors to move in the right direction. As I Said in previous post, diabetes, blood pressure and cholesterol problems are the leading health factors. I am schedule to have a sleep study in a couple of weeks as my wife now tells me she thinks I have sleep apnea. It wouldn’t' surprise me at all. No matte what I do I can’t seem to drop weight anymore. There are other health problems related to muscle and joints that are showing symptoms regularly as well.

 

 

I have been for more than 20 years. The last time I Was at a normal weight was when I was 18. I spent most of my time partying and drinking and managed to drop from 240 to 170. IT felt awesome. I had the looks and admiration of people like never before. Of course as my life changed I Started eating regularly and attending college classes and the weight started coming back, slowly at first. Then before I knew it I was big again. I didn’t’ give it much thought until doing Atkins a couple of years ago. By that time I lost from 250 to 210. Of course we all know the side effects of the Atkins diet. I had then all. Then for personal reasons the diet ended and the weight slowly crept back on. This time I have not been able to stop it. I exercise until my body is worn out and sick. Then I am just worn out. I have done the atkins diet, Jenny Craig, and just plain old exercise and small meals. Nothing works. I am always miserable, hungry or sick from not eating and so forth.

 

 

I am pretty sure that this is the path I want to take. 99% sure even. Now I just have to get the sleep study done and see my physician to get a referral to a Bar iatric surgeon. I am worried that I may have problems since I have only been with this physician for 6 months. The one before this was an idiot that I should have left years ago. He kept no records and has documented nothing that is helpful for me. He has no records of the 6 months I was on Xenecal and lost 9 pounds or the 6 months I   meridia and gained 15 pounds. I am worried that the insurance will make me go through all of this over again. WE shall see where the journey leads.

 

 

As for the skin questions it is more directly related to the experiences of a friend. I have a close family friend that had Gastric Bipass and has shared with me that he is as disgusted with all of the loose skin as he was with being over weight. That combined with his lack of overall success make me worry. He went to the doctor about the skin and the insurance refused to cover any procedures. Even though I am over weight now I am comfortable taking my shirt off in public, at the beach and so forth. I don’t think I would be if I had skin hanging all over. Again, we shall see where the journey leads. I know that when I lot the weight the two previous times I had no skin problems but I don’t’ think that was as drastic as what will be from the surgery.

 

 

Again thank you so much for your kind words. I feel very reassured after reading your post.

 

 

Brad

 

 

Your so welcome, Brad.  I've gotten so much support on this board, I'm thrilled that i could give comfort to someone else for a change.  I'm truly blown away by the similarity of our experiences.   Have you made your mind up about the lap band?  I would encourage you to hang out on the lapband support board on this site for lots of great information.  I was convinced that I wanted the lapband and only the lapband, but during my extended wait (to get cardiac clearance) I have reconsidered, and have decided to have the VSG.   Have you found a surgeon yet?  If they have a support group, it would probably be a good idea to drop in.  At least you and your wife could hear from other post-ops besides your one friend.  Coincidentally, I posted on the VSG board last night about a very overweight co-worker of mine, whom I just discovered already HAD RNY.  I was freaking out, thinking, geez, if he can gain it all back plus more, I'm SURE I will!!  But everyone talked me down and made me realize that my success is in MY hands, not his.  His self-sabotage is no indicator of my will to succeed.  It's hard not to compare ourselves to our friends.  But we are all physically and emotionally so different.  It's impossible to predict whose results we may mirror. Glad to hear about your insurance and your new doc!  You're on your way!! Jen

Hi Brad,

With insurance, medically necessary generally means that you are waiting for an organ transplant. It does not mean necessary because your comorbids are killing you. That being said, do you have a BCBS FL federal, state, or self insured plan? If so, there *may* be hope.

As for your second concern, my new favorite blogger just wrote, "no one ever died from hanging skin."

I hope this helps.

Kristen

News that makes me feel good. I spoke with BCBS of Florida State PPO this morning. The lady was extremely friendly and helpful. She even told me about a friend’s success with the surgery.  So here is the answer to my own questions for anyone else in need. This insurance plan will cover the surgery if it is medically necessary.  We all know that the definition of Medically Necessary is BMI > 40 or BMI> 35 with diabetes, cholesterol, sleep apnea and blood pressure problems. They will cover 80% after the 250 calendar year deductible.  The hoops: Need a Psych evaluation, GP must write a letter explaining the medical necessity including possibilities of stroke, 6 months of supervised diet and no weight gain related to thyroid problems. BCBS also requires a history of weight problems 5 years or more. I have been overweight since I was 11 or 12. So I don’t think the history will be a problem though I have only been seeing my current physician for about 6 months. She is or has been very receptive to all we have discussed to this point about medical treatment so hopefully that won’t change. I think I will meet all of the requirements. Not really sure what they do in the Psych evaluation though. They might find that I am crazy (ha ha ha ha). Maybe someone who has experienced this can discuss a little?

 

 

My sleep study is scheduled for August 31 I have no doubts at this point that I have at least mild sleep apnea. My wife tells me that she thinks I do as well base on my sleep patterns. I go for a follow up visit in October to my GP. I may move that appointment up some in order to get the ball rolling towards surgery. I was very pleased to read and hear about how people have been able to go off their meds after surgery. I hope to have that same success. With all that I take it will pay for my cost of the surgery in no time.

 

 

Now for the most difficult part, I have to start talking about this with my wife. She has been negative about WLS after our friend’s experience. We actually know two people who have failed after having Gastric Bypass surgeries. I do hope that she will be supportive of my decision. I know this is the right thing for me to do and will be beneficial to our family in the long run.

 

Brad, I am glad it looks like you got your questions answered. I just wanted to tell you to stop over on the LapBand board when you get a chance. There are many of us there and you will find answers and support to many many questions, which might help you tell your wife about the surgery. Hope to see you over there! And feel free to ask lots of questions! :)