Introduction and Burning Question

Good Morning Everyone, I just wanted to introduce myself and then ask a question. I am 33 yrs old. I have been overweight and/or obese all of my life. Currently I am 5'8" and 274 pounds. This is 10 lbs down from the highest recorded weight of 284 in July of this year. My PCP actually brought the WLS option up before I did and has made an appoinment with a Bariatiric surgeion for me in Jan. 2007. I do not as of yet have major health problems but have "smaller" ones which will lead to bigger ones as I age. My question is about insurance. They will want me to loose 10% of my origional body weight before the surgery is approved. If I do this at my current weight it will put my BMI below 40. What should I do? I could go ahead and diet and get the 10% off and have a BMI below 40 or do nothing and probably gain some or maintain my current weight. I am not sure what to do on this one. Any feedback would be greatly appreciated. Thanks in advance, Lisa

Hi Lisa and welcomed. Now slow down and take a deep breathe. You're getting frazzled and you have a long ways to go. First off you need to check with your insurance to see what they require for you to do. Most require a 6 month Dr. supervised diet and monthly weigh-ins. Second what surgeon are you being referred to. You will need to find out when they have their seminar as you will need to go to that. What small health problems do you have at the moment? You will need a letter of referral from all your Dr.'s stating it is medically necessary for you to have this surgery and get copies of all your records. If you have sleep apnea, you will most likely need another study or a sleep level test. Get that scheduled. If you have heart or lung problems get those records and letters from those Dr.'s plus a current follow-up. If you have an Hiatal Hernia, you will need to see a GI Dr. and have the scope done to make sure everything is ok. Get those records and Dr. letter. Don't worry, the hernia will be fixed while you are in surgery. If you still have your gall bladder, you will need to have that checked ultra sound and get the report. Your PCP can set up all these appointments. After you see the surgeon he/she will give you a list of what they also require. So you will be real busy for the next 3-6 months depending on your insurance. It sounds like a lot, but it makes the time go faster. When you contact your insurance, also ask if this surgeon and the hospital are in the insurance network, if not then you will need to find one that is. So for the moment start with the insurance. When you see your surgeon for the first time, he/she will need to know if your insurance is going to pay for your surgery. You will need a letter from the insurance company on their requirements. You will be kept busy. Also I would recommend a complete physical and mammogram before anything else. I say that because you will need a battery of blood tests. Make sure your chloestroil is normal, your WBC is in normal range, RBC is in normal range. I have my surgery last January, and I went into knowing I had leukemia diagnosed in July 05. My surgeon agreed as long as my blood count was normal. Now I have cancer in one of my lymph nodes from the leukemia. Not all the surgeons ask for it to be done, but I have run across several that require a complete physical and mammogram first. Play it safe and get them done. Plus the blood work. Everytime you get blood work done, request a copy of it. Then you can keep an eye on it, where different Dr.'s may not pay attention to it as closely. I truly am excited for you. And I'm not trying to scare you, I just want you to be prepared for what lies ahead of you. Best wishes and keep posting, you're going to have a zillion questions to ask over the next few months. May God travel with you on this new journey, Kathy

I have Blue Cross. The same question came up before losing my 10%. The 40 BMI is preweight loss.

Kathy, The following is taken directly from my insurance company's (Blue Cross)website. The big thing is knowing whether to go ahead and try to loose the weight before I see the Bariatric Surgeon in Jan or just wait. Twenty eight pounds isnt a great deal to loose but it will take me a little while. I guess I am already down 10 so I only have 18 to go. Which will put my BMI below 40. The health problems I have now are: arthritus in both knees, back problems, stress incontinance, polycystic ovarian disease, high LDL cholosteral and low HDL and depression. Thanks for all your input, Lisa Bariatric surgery, using a laparoscopic or open procedure, for the treatment of morbid obesity is considered medically necessary if the medical appropriateness criteria are met. (See Medical Appropriateness below.) Any device utilized for this procedure must have FDA approval specific to the indication, otherwise it will be considered investigational. MEDICAL APPROPRIATENESS Bariatric surgery, for the treatment of morbidly obese individuals 18 years or older, is considered medically appropriate if all of the following criteria are met: The Pre-Bariatric Surgery Evaluation Tool must be completed and submitted with the request for authorization; and The attending physician must submit evidence that the attempt at conservative management was within two (2) years prior to the planned surgery; and The attending physician must submit records that the individual has successfully lost 10% of initial body weight prior to the date that the authorization is requested; and The attending physician must be someone other than the operating surgeon and his/her associates; and The individual has a diagnosis of morbid obesity that has persisted for at least five (5) years, and is defined as either: More than 45 kg (100 pounds) over the ideal weight or at least twice the ideal weight. The ideal body weight can be determined from the Metropolitan Life Height and Weight table; or BMI is greater than or equal to 40 kg/m2; or BMI is greater than or equal to 35 kg/m2 in conjunction with any of the following obesity-related co-morbidities that will reduce the individual's life expectancy: Coronary artery disease; or Type 2 diabetes mellitus; or Obstructive sleep apnea; or Three or more of the following cardiac risk factors: Hypertension (BP greater than 140 mmHg systolic and/or 90 mmHg diastolic); or High density lipoprotein (HDL) less than 40 mg/dL; or Low density lipoprotein (LDL) greater than 100 mg/dL; or Impaired glucose tolerance (2-hour blood glucose greater than 140 mg/dL on an oral glucose tolerance test); or Family history of early cardiovascular disease in first degree relative (myocardial infarction at fifty years of age or younger in a male relative or at sixty-five years of age or younger in a female relative). Psychiatrist/Psychologist must submit all of the following: Documentation of the individual's willingness to comply with both the pre and postoperative treatment plans; and Interview/evaluation results; and Minnesota Multiphasic Personality Inventory (MMPI 2); and IQ screening (any screening accepted by the American Psychological Association); and The Eating Disorder Inventory (EDI-2) or the Eating Attitudes Test (EAT-26) NOTE: If any of the above (Interview/evaluation, MMPI 2, EDI-2 or EAT-26, or the IQ screening) provides a suggestion of cognitive slippage or psychosis, a predictive test (e.g., thematic apperception test (TAT) or the Rorschach test) is required.

Hey, believe it or not, this is pretty standard stuff. I think you will be okay and like Melinda said, the bmi is pre weight loss. If you are still worried, like I was no matter what anyone told me so I understand!, go to the BMI calculator on this site and plug in the numbers of what they would be after the weight loss. I think you will be okay...by the way, obesity is 30 and up so are you sure it says 40? By the way....WELCOME!