Not so sure yet!

Hi, I am Bobby... I am not sure(about 50% sure) about lap band surgery. I am on a desprate hunt for more information about Lap Band Surgery. I am not even sure if my insurance will pay for it. I am disabled, and their for on N.C. Medicaid. My doctor has told that medicaid will pay for it as long as I find a Dr. that will accept medicaid... And as long as he states I am Morbidly Obese. And he has stated that fact. Now I just need to find more info.. on Lap Band Surgery and get Medicaid to approve it( crosses finger). If anyone has any good info or bad info about Lap Band. I would gladly appreciate it. Bobby

hi bobby,i am pretty sure that medicaid only pays for rny surgery. they require a 3-5 yr history of being morbidly obese. they require you to have comorbidites too, like diabetes, hypertention, arthritis, and vericose veins. along with the 3-5 yr history of obesity, they requre that it be medically nessessary and require a 6 month consecutive supervised diet. i have medicaid and i turned all my paperwork in for insurance approval back in sept. with a denial to follow because i didnt have a supervised diet. i then started going to the doctor for 6 visits once a month and followed them with a visit to a dietitian at my local hospital for a back up so that iwould not get denied again. i was approved on feb. 16th and was scheduled for surgery on march 13. i am 4 weeks out and down about 40 lbs. whooo hooo. i hope this helps. and good luck, adrienne

I had very severe chest pains when my went bad. I was scared to death thought I was going to die. Then with each attack felt lik e my stomach was in worse & worse shape. HTH!

Also yellowing of the skin due to bile backup. Usually hands, feet, face. May feel similar to a bladder or kidney infection. Or sometimes there is no symtoms until tests are done for some other reason. Glenda

Hello let me tell you what medicaid requires...Adrienne did a good job she is great....have to be 19 yrs old or older ..BMI of 40 with no co morbid conditions for 3 years but who are we fooling if you have a BMI of 40 you have something going on if it is only a back ache and knee pain...ok..BMI 35 or above with co morbid conditions such as like Adrienne said...diabetes, heart disease, hypertension, sleep apnea, shortness of breath, stress incontinence and the list goes on...but you must be diagnosted and being treated for it by your primary doctor... the biggest thing with mediciaid is DOCUMENTATION like doc. notes X ray and and different types of test that is why we require them for your safety as well to see if you have things wrong that you do not know about as well as back up what you are being treated for...if you have sleep apnea for example you should have a sleep study...if you do not then how can u be diagnosted with this condidtion....Ok and here comes the main one that they want and will not approve with out it...6 mths supervised weight lose with Primary doctor....like Adrienne said she went to nutrition to have a back up but make sure the diet and exercise program u are on is documented if you do not know what needs to be put in the notes I can help you as well as Adrienne she knows what i told her and what she had to make sure was there...make sure in the documetation that it is noted that u have attempted varies was to lose weight and what they were with no long term results...If you are a diabetic a fasting glucose is required to be done....for some reason they do not want a A1C...but if you have one then it should be sent...and you have to have a PSY consult and a nutrition consult they rest should be handled by the surgeons office....Ok now about which surgery is covered...these are the codes that are covered 43644 lap RNY 43846 open RNY 43842 and the other 2 I am not sure of but can find out when I can get a hold of the CPT code book I think the surgeon has it with him ....43842 43659.....ask a surgeon is one of these codes a procedure that he preforms we do not do lap banded for different reasons and it is not because the surgeon can not preform them but like he says it is to experimental at this stage and in time I may do them but right now I chose to do the safest and more effective surgery which in the Roux-en-Y....well if I can help you anymore let me know I have all the requirements for the surgery if you like a copy just let me know.. Jennifer Advanced Bariatric Center

I had a gall bladder attack and I thought I was dying. It had hurt me before right below my right boobie, I would feel nauseated and everytime I moved it felt worse. When I had my attack I had hurt all night, but I woke up in excruciating pain, I was doubled over and I could not walk. I was screaming for my hubby to call 911. I was afraid I was having a heart attack. I made it to the hospital and they did an ultrasound, and it was terribly painful, and they discovered my gallbladder was full of stones, red and inflamed and had fluid surrounding it. I was scheduled for emergency surgery and had it taken out laproscopically. I feel 1000% better since that thing is out of me!

If the Lap Band is the same thing as a Vertical banded gastroplasty (also called vetical banded gastric partition or vertical gastric stapling) then Medicaid does pay for it. I had to make the decision too. But I just didn't like the fact that there was a port (where the saline is inserted in) on the outside of my body. You have to be very careful with it. I would be just so self conscious of the thing that I wold probably hit it anyway or some how damage it. If you are not disciplined you don't learn to eat well (in my opinion) because you can eat anything you want. There are no diet restrictions. That is what I need to aid me in my over all weight loss. I have heard that there were a lot of adjustments later on that have to be made due to internal problems. It is a foreign part inside of you and your body may try to reject it by building up scar tissue arround it or even moving it. If you find that Lab band is not for you (after you have had the surgery) you will have to weight years before the gastric bypass can be considered by insurance. This is what I got from my research when I was trying to decided between the 2 surgeries. May be you should post this same question on the Lap Bad board as well. If you send me an email I will sent you the actual medicaid coverage policy for you to review. Good luck in your decision and your journey. Phenom

Bobby, Good Luck with your decision. I am not here to sway you either way, I chose rny after careful consideration of lap band. i have health insurance through my employer and they cover both rny and lap band. HOwever, I was gungho to have the lap band when I first began looking into wls. I decided however, first that the maintence is too expensive, I cannot afford between $200-500 per fill. What if I change employers and don't have fills covered or wls, these were all things I weighed heavily. I checked with my dr and he requires the $$ upfront an then submits the insurance, I know the hospital does it too under flor or something like that, ofcourse it's your surgeon doing the fill. THe reasons why I chose RNY 1. Only 1 time under surgery 2. Only Medical Visits for Maintence 3. The expense and time off work for fills and maintence 4. RNY is not reversable, so I've got it for the rest of my life. 5. I cannot say enough good things about my surgery, and surgeon. My recovery is awsome. I was on the lighter side 243 and now i'm 208 and i'm only 6 weeks out. I love it, I cannot overeat or eat the stuff I like, this was truely the right fit for me. I think the lap band is a huge investment, plus it does take dedication and discipline. I wish you luck in your decision. Just do a google search for lap bands and you'll find a wealth of resouces.

Thank you Sonya! I'm trying really hard to stay focused and keep on track and stay off the scales. Sheri

There is a good forum for LapBands, www.lapbandtalk.com I was debating between Lapband or Rny. I will be going Lapband. But its a personal decision, only you can make. GodSpeed and God Bless.