New and approval process

Hi, I'm Katie and I am new to this site. I have struggled with my weight my entire adult life. I have 5 beautiful children and I'm a busy stay at home mom.

I attended a class yesterday as a first step to getting the Lap band. I am 5'6" and I weigh 220lbs. That puts me at about a BMI of 37. I have Bluecare HMO insurance. The nurse running the seminar said that they probably would not approve the band for me because I am too small and would need to have a severe co morbidity. I have high blood pressure, my cholesterol is high, I have edema in my legs and I get migraines. I had Gestational diabetes with all of my pregnancies and I'm pretty sure I am hypoglycemic now. I have to make an appointment with my primary because it's been about a year anyway. I am so disappointed that they didn't seem to take me seriously. I have been on so many failed diets I can't even count them and I just gain MORE weight with each failed attempt.  Did anyone get approved with the same kind of insurance in Pa with a similar story? I am reading, reading , reading and I want to thank you for all of the wonderful information on this site!

High blood pressure and high cholesterol are serious co-morbid conditions.  I guess I don't understand why the nurse running the seminar did not know this information.  Did you share with her that you do have co-morbid conditions?  To boot, the NIH just changed the guidelines for adjustable gastric band to a 30 BMI with a serious co-morbid condition.  You still qualify.

I'm not sure what the NIH is? I did tell her about these things. She said I would have to have sleep apnea, diabetes or CAD. I told her again about the BP and cholesterol and she said no . She said I would had to have a heart attack or a cath procedure or something to qualify. I guess they prefer if someone has a heart attack and then they would turn around and say "you're too much of a risk to get the band". Who knows!

Katie,

Maybe you might want to look elsewhere for your surgery. I don't know which part of the state you are from but Barix Clinic in Langhorne is an EXCELLENT place to go! I think they do lapband, but they do more RNY/Gastric Bypass. There is also a wonderful support group that meets there on the first Saturday of the month and the third Wednesday of the month for post ops and the second Tuesday of the month for pre ops. Some insurance companies are very picky about who they approve for this procedure. You might have to put up a fight!!

Good luck and keep us informed on your progress....

Beth

if you feel the lack of attention and concern from them now , how do you think they will treat you after surgery? sometimes you just have to check out more than one place.
good luck , it will be worth the aggrevation.

First of all - welcome Katie - we are hopeful that you can get the information you need and the questions you have answered here on this site.  We are here to support, love and laugh with each other.  I don't know anything about the HMO you have, but I have to agree with Cheryl, sometimes, the first place you look is not the right match.  I know in my experience, it was a four year process until I found the surgeon and facility that I "Matched" with.  Barix in Langhorne PA was the place for me.  I had looked at a few other facilities and surgeons throughout my process.  If you are not happy with what this nurse said, move on - as someone else mentioned, the requirements for the band have changed and you will want to find a place that is well aware of that and will take you seriously.

Good luck with this process and remember, you are doing this hard work for your health - it is a tough road, but one worth traveling!

HI Katie,

NIH is National Institutes of Health.  They set guidelines for bariatric surgery among other things.

I agree with ALL of the others who have said to "find the right fit." I know that before we even get people started in our program, we verify their insurance to make sure they have the benefit AND I make sure I know what is required to get them approved.  HYPERTENSION IS A CO-MORBID CONDITION! Please find a program that WANTS to work with you!

She was telling me that hypertension was not a severe enough of a comorbitity with my insurance. Do all insurances that pay for the surgery have to follow the NIH guidelines?