Tufts Health plan

Hi to all, Does anyone have Tufts insurance and have a BMI of 35 with 2/3 co morbities? If so, were you approved for surgery? I had my first intake today and the Dr. thought it may not be good w/ the ins. company. I am however, going on in the process w/ the dietician and behavorial appts. I have a copy of the Tufts coverage criteria and I fit. Thanks Kathy

Hi Kathy I have Tufts but my BMI is over 40. I read their requirements on their website - just search for "gastric bypass" on their website - and it has specific co-morbs necessary for those w/a BMI under 40. I don't remember exactly what they were but check their site. I remember thinking that I was glad that my BMI was over 40 because while I have hypertension I did not have 2 of the comorbs they listed. You can always call them directly. I was approved the day after my doctor's office sent them the paperwork. Good luck! Kathleen

Kathleen, Thanks for the reply. I do have a copy of the web page and according to it I would meet the requirements. The Dr. at Umass did not seem confident about that. I do have the appts. set up though. Kathy

what's the webside address for them Kathy? Thanks.

Marie, Go to Tufts Health Plan hom page, then put in gastric bypass criteria. KAthy

Which hospital are you going through kathy? If you don't mind sharing, what kinds of co morbitities do you have? The reason I ask is because I have Tufts HMO and my bmi is 38 and I was scared that I wouldn't be approved too. I'm not at the approval stage yet but I did go and see the nutritionist at St Elizabeths hospital in Brighton. I have joint pains...back and knees and also high cholesterol. She said that I could be a candidate for the surgery (lap band). I have another appointment for the Psych and also to do blood work at the end of February. Hopefully all goes well then and I could mover closer to getting approved. I've been told that joint pains is a co morbility. Is that true? Good luck and just don't give up. Your profile says that your bmi is 31....is that correct?

Hi Marie, I am going thru UMass Memorial in Worcester.I have : diabetes, high cholesterol, depression (although not serious, but enough for medicine) and unrinary incontinence. I also have back pain, although not always. My BMI is actually 35. My PCP said UMass. There is a page on Tufts to look at the criteria. That is great info. Look at them. I have been told that if you want the gastric bypass and you qualify, you don't have to go w/the lap band. How do you feel about the lap band? Thanks Kathy

Hi Kathy....sounds like you will be okay and get approved. I rather do the lap band because it is less invasive....no cutting or realigning my insides. For some people that's okay...but I rather do the lap band. You lose slower than the gastric bypass but I think it's better for me. Which one do you want to have? I should ask this question to the OH members...How do you feel about the lap band verses the gastric bypass?

Hi Marie, I thought about the lap band but, I am concerned about having to have the periodic fills,and, the band can break. Things like that. But, according to my info, after 5 years the weight loss is the same as the gastric bypass, which I am leaning towards. There is also concern to the gastric bypass. That scares me too., No matter which way, it is still surgery, and that is always risky. I am trying to think only of the result, to get healthy and feel good. I have two sisters who had the gastric bypass and are sooooo happy. Kathy

You are absoltely right...surgery is surgery....and wls is just a tool no matter which one you have to help you learn how to eat better and less. When you really think about it, it teaches you when you are full which is to eat portion control meals and you have to change you diet and eat much healthier. Basically...it's just an aid to what I already know but just couldn't do it without wls. I will be fortunate and blessed to have the chance to do this and start to live my life. Good luck to you and your surgery.