Insurance

I would like to have the lap band surgery but am wondering if anyone knows if BXBS would pay for it.  I have a BMI of about 40, high blood pressure which is controlled by drugs, back problems (previous surgery), arthritis in my knees and ankles, (have just had a sleep study but don't know the results).  I have lost and gained 100 pounds five times in my life following a new drug.  The last time was three years ago.  I took an antidepressent and lost over 100 pounds.  I can never keep it off even for a day.  Will the fact that I was thinner three years ago disqualify me?  Also how much pain is there and for how long? Thanks

I also have BCBS insurance.  The way my policy reads is that if you have a BMI of 40 or above, you do not need comorbidies.  My BMI is 39 and it took me a year to get approval, but I do have comorbidities. Depending on where you would like to have this done, you probably would want to call the surgeon's office and find out what the requirements are.  The gastric bypass coordinator probably can tell you if you meet the requirements. Not to say they will be able to let you know if you will be approved, but probably could get the ball rolling with the supervised diet, psych exam, etc.  I have sleep apnea, but the way my insurance reads is if the comorbid condition is controlled with medication or CPAP, it doesn't count. I think there has to be documented history of weight for a number of years, but I can't remember if it is 3 or 5.  My approval took a very long time, and surgery for me is on July 2nd. Good Luck to you.

Thanks Lori.  I was really concerned about the three to five years thing.  I have been over 100 pounds overweight for at least about 9 years of my life but in the last three years I did lose weight because of a medication only to put it back on. I have an appointment on the 26th of June at Mid Dakota for all the appointments and to meet the surgeon.  I will take your advice and talk the the coordinator then.  Is there anything I should definitely ask? Also, what is the psych eval like?  It seems scary. Thanks so much for your help.  This is such a big step.  I am excited but also a little afraid.

The psych evaluation was a piece of cake.  I was scared too.  I thought for sure they'd find something to disqualify me...LOL, don't know what, but it was scary. Once I got there I took a computerized test, it kind of seemed they were asking some of the questions in different ways.  It was really nothing I should have worried about.  Then I met with the doctor (psych), and she reviewed the test and said she would write a letter supporting surgery. Good luck to you.