Know it will be difficult to get approval-any advice?

Hello all-  Right off the bat I'll say I expect some negative reactions here, but I have a unique situation. My BMI is only 32.  My "good" weight in my 20's was 115 pounds  .I have a spinal disorder (cervical stenosis, several bulging discs cervical and lumbar) severe radiculopathy pain in arms and legs, and can not do any traditional exercise. Walking is all I can do. I also have chronic fatigue syndrome (unconfirmed) but have had it for over 20 years so I know it is very real. I have fibromyalgia but have it controlled as long as I can get adequate sleep and take my medications at bedtime. I do not have DM II or  hypertension.  I do have arthritis, high cholesterol, history of mild depression that is completely controlled, and sleep apnea that is unconfirmed. .   I have 4 children and worked out of the home until I could do it no longer 5 years ago, due to fatigue and pain. I gained alot of weight while working full time at a corporation from age 38 to 43. I started a home based company four years ago, am very happy with it.  I  work very hard, regardless of my CFS and pain.  I have tried weigh****chers, several diets, numerous over the counter drugs, and can not tolerate most diet and herbal drugs. I get fatigued very easily so even the walking can knock me out for half the day.  Of course, many people say, "oh you look fine" at 185 pounds,  but I don't feel fine. I fear that by the time I get to the more "accepted" BMI of 40, I will be fully disabled. Spinal surgery is a last resort for me. I have worked for a neurosurgeon and know the risks of Spinal surgery are far worse than Lapband or gastric bypass. I have 3 friends that have had gastric bypass and they are all very happy. One had a similar situation with spinal disorder, and low BMI, but she was self pay for her surgery. I do not have the money to pay for the procedure. So , thats the story..( probably should be on a Chronic fatigue forum, right?   lol.)   I'm just looking for advice and I'm prepared for the truth, so go ahead.. give it to me!   Thanks !!

Hello, May I suggest you try and post this on our Lightweights forum?  Here is the link: http://www.obesityhelp.com/forums/wls_lightweights/ Good luck to you and if you need any further help, please let us know at [email protected] Take care, Kathy

Hi I just recently signed up too and I have to say that every insurance is different and I know how you feel.  I just got the word that my insurance approved my lapband procedure for the 22nd of this month and I was surprised because by bmi is about a 38 or so. 

Congratulations on your approval! It is encouraging to hear you were approved - Best of luck to you!

Hi, no negative reaction here, sounds like you have your hands full.  Have you seen a bariatric surgeon yet.  What does your PCP say, and your other health care providers about WLS.  You have co-conditions, while maybe not all counted as co-morbidities, they are detracting from your quality of life and it seems that it will only get worse.  A viscious circle, not fair.  You will have to do a sleep study amoung other tests.  If I were you I would start with a consult with a surgeon.  There are many good doc in NJ, I can recommend a few based on your area. Write back if interested.   Something that did raise a flag is your fatigue.  My LapRNY was 4/30/08 (2 weeks post-op today) and I am exhausted and I don't have most of your health conditions.  Finally got my bum out the door today and walked for 1/2 hour. How well will you get through this initial stage of recovery, everyone is different. I wish you the very best, keep writing, you never know where help might be found.

Thanks for understanding- I haven't seen a surgeon yet.   My Primary is very busy.didn't have much of a copmment, but basically suggested other weight loss options and physical therapy.  Yes, I would be interested in names of surgeons. I do have a PPO so I can go just about anywhere that takes Horizon BS.  I had a script for a sleep study but didn't get around to it yet.  (Its hard to fit everything in.)   As far as the fatigue after surgery I would have to adjust my work schedule and get extra help. I think I could handle it.  I did post on the lightweight forum, and most/all say I wouldn't be approved at 32 BMI- One woman went to Mexico for a self pay procedure..  not a realistic option for me..   Thank you for your help!!  yes, you never know where help might be found.. 

hello first of all i wish you luck with your quest for weight loss surgery.  i understand your concerns due to your health conditions.  i know this is not what you want to hear, but from the way you described your health, im not sure that this would truly be the right surgery for you.  this is no easy fix. it will mean a major change in your life and lifestyle.  it will most likely mean a supervised diet for six months, something many insurance companies are requiring today. having said that, i agree with the other poster, that your first step is to talk to a surgeon or two and see what their feelings are on your situation.  they will be able to tell you what your chances of approval are.  they may also have some suggestions as regards your other medical conditions. good luck with all of this and keep us posted jacki

Hi First, I would like to say that I have been on this board for a year now - I started "lurking" 6 months before my surgery - and I have never seen anyone on this board be nothing but supportive and helpful, so be prepared for some support & help!   The best suggestion I can think of would be to talk to the insurance people in your doctor's office - they have been through it so many times I'm sure they can help you out.  Remember, for every "rule" there are a million exceptions and whether you qualify by the rules or as an exception because of your medical issues - the results are the same - Approved for surgery! Just follow the insurance companies instructions to a "T" - if they want a 6 mos diet - just do it.  Whatever they want do it and don't give up!!! Good Luck!!!

I haven't heard of anyone getting approved with a BMI under 35. 32 is not far off. Are you SURE you are using the right height to figure out the BMI? I have had assorted people do my height and the range has been between 5' 6" & 5 ' 8. No kidding! Good luck!! Bernadette