New to this Site

Hi Everyone! I'm from Trilla, Il(you've probably never heard of it) I'm married, the mother of two children a 3 year old daughter and a 1 year old son. My family means everything to me. I work full time and my sister and I are trying to start our own business in our off hours. Okay, here goes.... I'm 6 ft and 265 lbs. I was surfing the net a while back and came across Lap Band surgery. It sounded appealing to me because the incision is laproscopic and it is reversible if needed. I called my insurance company which is Personal Care and they do not cover Lap Band, however with precertification, they do cover Gastric Bypass. So I started reading about it and am really excited at the prospect. However I have to get past the precertification hurdle first. My BMI is 35 - 36, I have severe hypertension(even with medication it is still considered high), I have joint pain, fatigue, forget what you call it, but skin gets "raw" where my stomach has a roll(ughhh, not very appealing sounding), I think I have sleep apnea, though I've not had a sleep study, but my husband says I snore like a bear, I fall into deep sleep in middle of conversation, and never feel fully rested. I've got an appointment with my family doctor to try and get a referal for sleep study and with both pregnancies I had Gestational Diabetes, which puts me at a greater risk for developing Diabetes. From all your experience, do you all think I'm a viable candidate for Pre certification of this surgery? I want to be here for my family for many years to come! I want to play with my babies every time they ask, instead of only when I've got an energy burst. I want to be able to buy the clothes that are so pretty and look good in them. I want to be healthy! I've tried Weigh****chers, TOPS, Low Carb, Low Fat, Sensible eating and moderate exercise..... alittle will come off, then it stops, I get discouraged and then I gain it back. This has been a battle for 23 years! I have an appointment with Dr Rorsheib(not sure that is spelled right) in Clinton, IL on November 4th for my first consult. If I don't qualify, I don't know what I'm going to do! Thanks in advance for your responses!

Welcome to the IL Board, Sandra! I quite honestly must say that I do not know what the specific requirements for bypass approval are since it seems almost every insurance company has their own ... MY insurance requires 100 pounds overweight ... and that's about it ... any comorbidities (which it sounds like you have a few) only help (for approval) ... Anyway ... just wanted to say HI ... I don't know anything about your doctor ... I used John Alverdy at Univ of Chicago Hospital. Post questions ... these gals on here will answer anything!! Nancy 353/235/170

YIKES ... No offense meant, guys!! What I meant was ... these wonderful people on the IL Board will answer anything!! Nancy

Sandra, Gastric bypass can also be done via LAP incisions;) Although the band is reversible, thats not really the way surgeons or patients look at it. It is considered a permanant change both to your anatomy and your lifestyle. Remove the band, regain the weight kinda thing. As far as your insurance goes, many ins. still view banding as experimental. They need to get with the program. These are the same insurance companies that are still offering an orthodontics benefit of 900.00 when braces can cost 4200.00. (GRRRRRRRRRr.. personal beef!) Anyhoo, the worst that can happen is they can tell you 'no'. IMHO its defintely worth a try. I believe with your comorbities, you would qualify for surgery...if you found a doc that knows how to work it. A great letter of medical necessity from a surgeon speaks VOLUMES Keep us posted! Love, Dixie aka Kathy

Yep, I'm thinking I'm going to like it here. You guys are all very nice to reply to me. I look forward to talking to you all more. Thanks again for the replies. Sandy