advice needed:help

Hello everyone, I am at the very beginning......kind of. For the past 1 and 1/2 I have seen several doctors and at best, alot of wasted time. I am now waiting for a consultation in January 2005 with hopes I can get help with my life long stuggle with weight. My BMI at present is 39 and between health insurance confussion and not finding a helpful doctor I don't know if I will ever receive help. My questions are: 1. Out of four insurance plans choices I have at work which one would be most simathetic (Health-Net HMO, Jersey Plus, AEtna, AmeriHealth HMO) 2. Anyone out their who has LapBand please tell me your success and struggles. Thank you all and I am so happy I found this wonderful resouces. Sincerely L.

I can only tell you about Aetna. They will only pay for Lap Band in limited cir****tances. Here is a the text from the Clinical Policy Bulletin that mentions Lap Band: # Vertical Banded Gastroplasty (VBG) and Laparoscopic Adjustable Silicone Gastric Banding (LASGB or Lap-Band): Aetna considers open or laparoscopic vertical banded gastroplasty (VBG) or laparoscopic adjustable silicone gastric banding (LASGB, Lap-Band) medically necessary for members who meet the selection criteria for obesity surgery and who are at increased risk of adverse consequences of a RYGB due to the presence of any of the following comorbid medical conditions: 1. Hepatic cirrhosis with elevated liver function tests; or 2. Inflammatory bowel disease (Crohn's disease or ulcerative colitis); or 3. Radiation enteritis; or 4. Demonstrated complications from extensive adhesions involving the intestines from prior major abdominal surgery, multiple minor surgeries, or major trauma; or 5. Poorly controlled systemic disease (American Society of Anesthesiology (ASA) Class IV).

Louella, unless you have a co-morbidity (diabetes, high BP, sleep apnea..) your BMI has to be 40 to get insurance approval. It would also be good to have a documented 6-month attempt to lose weight (diet and excercise) and have your primary ready to right a letter in your support. I think it is harder in general to get approval with an HMO than a PPO. All the rest (bloodwork, cardio check, psych eval etc) that your surgeon may require can be done when you finalize your surgeon selection. I think there may be a board here for lap-banders(?) Jen

One more thing. The thing that really matters most, is what is in your health plan. Aetna will approve and have guidelines on bariatric surgery, but if your policy has an exclusion for that you'll be out of luck. irene

Best wishes to you, I found this on OH, check it out. Hope it helps, hang in there. http://www.obesityhelp.com/morbidobesity/bariatric+surgery+insurers+in+new+jersey.html