New here...

Hello, I've posted in the LapBand forum  a couple of times but now I've managed to find my way here.  I am just in the process of researching WLS.  I have been trying to lose weight for many years now & I just can't seem to lose any significant amount and keep it off.  My BMI isn't as high as most who are considering WLS, and I'm afraid that may keep me from being approved.  I'm 5'4 and weigh about 195...I think that puts my BMi around 33-34.  I do have hypertension (going on 8 years now) and at my last visit with my doctor, I had a borderline high glucose reading.  I was sent for a 3 hour glucose test & it came back fine.  However, since diabetes runs in the family, my dr says I am at an increased risk.

Anyway, I plan to talk with my dr again about WLS (probably the gastric banding) at my next visit in a few months.  I jsut don't know what to say or ask.  I know she has had one patient to have WLS, but I don't think she's that familiar with it.  And honestly, I get nervous & even emabarrassed to talk about it. 

We have BCBS of TN for our insurance.  Does anyone have any experience with going through them?  I'd like to get an idea of how things work.  Also, anyone with a BMI similar to mine get approved for surgery?

Welcome!!

I think that you may not be a canidate for any type of WLS.  The standards from what I remember are as follows:

40 or greater BMI or
35 or greater with at least one co-morbidity (sp?)

You may be just under the requirement for WLS.  Dont give up though.
Try to work with your doctor on loosing weight and keeping it off.

Alot of the food choices that any WLS patient does is very healthy for a non-WLS person, maybe just a little bit more for satisfaction.
low carb, high protein, low calorie, low fat, etc.

Good luck
Michael.

I have BCBS of TN, but policies vary depending on what an employer wants to cover.  I had to lose 10% of my excess weight, prove a 5 year history of obesity, etc.  Just like surgery is individual, so is insurance.  I also have secondary coverage which was very beneficial in my case.  Check with your policy to see what is covered and what is required pre-operatively.  Insurance is so crazy!  Also, it's good that you're asking questions.  IMHO, the more you research and learn, the easier it is to talk about subjects.

In my not so humble opinion, the TN forum is a great place to hang.  We have a wide range of experiences with different doctors and surgery types, and are supportive 99 54/100% of the time. 

Thanks.  I was able to get a detailed copy of our WLS coverage...Right now, I don't think I will qualify...but I'm still going to speak with my PCP about it.  I plan to print out the documents BCBS sent me & take it with me to my next visit.

I appreciate all of your help.  And I won't be giving up just yet...

 I met someone at work who was trying to qualify.  We all have BCBS of TN and have the lose 10% clause (some have the 6 month supervised diet clause;  I think it's employer/policy dependent).

She had no co-morbidities but when she loses the 10% her BMI would be less than 40.  So she's not sure if they'll approve her at that point, because in order to fulfill the insurance requirements, she knocks herself out of the running.  A lovely catch-22.

I haven't heard anything about her for a few months. I hope she's able to get the surgery she wants.

Hypertension counts as a co-morbidity but I don't know if you need more than one.  But that with the potential for being a pre-diabetic and family history certainly can't hurt.

I was very fortunate--the clinic submitted my file and it was approved within a week.  But my BMI was over 40 AND I had multiple co-morbidities.

Good luck on your journey!
Denise

Thanks, Denise.

Unfortunately, high bp is listed under the "must have at least 3 of these conditions" and BMI of 35  or over.  I've never had my cholesterol checked, and that was one of the other conditions listed.  I'm hoping to find out more from my PCP in the next couple of months.

Our BCBS of TN policy requires the loss of 10%, too.  That would put me well below the 35 BMI cutoff.  UGH!  Insurance companies...!

I am not a doctor and I am certainly not qualified to say you are qualified or not but I think this surgery is a last resort. If you can still perform all your activities of daily living then maybe an increased exercise program and a low cal diet for a few weeks would help throw a few pounds. But if this is the last resort then good luck on insurance because they will do everything possible to keep you from paying, some people who know my journey will agree but I am 21 and I started college when I was 18, i dropped out due to my weight and health issues and I was barely approved this last november, december of 2008. They will confuse you, make you mad, make you try and mess up and put your doc through enough stress that they will even complain to you how difficult it is. My doc plain and simple told me that he better see me walking because he has never had to fill out so much paperwork on someone. So definitely try to avoid the surgery, I am glad I had it but I wi**** never would have come to it.

Justin, I appreciate your reply.  I totally agree that WLS should be a last resort.  However, I am not willing to wait until I can't walk around anymore to start trying to get something done.  Yes, I can still perform daily duties; however, my quality of life isn't what it should be for someone my age.  I can't run around with the kids & I can't do other things that I WANT to do so badly. 

My last example of this is when we went to the Chattanooga Aquarium with the kids in Feb.  My feet & legs were so swollen and they hurt so badly that I had to sit down frequently while going through the last aquarium.  I couldn't enjoy myself and enjoy my kid's experience because I hurt so bad, that's all I could think about...I just wanted to sit down!!

I know I may be in for a fight with my ins co. (I don't even qualify right now...) but I am trying to figure out a way to be prepared to self pay within the next couple of years.  I honeslty don't want to wait until I'm shut up in my house until I do something.  My kids deserve so much more!

I've battled my weight for years now.  I lose a bit only to gain all plus some back.  I'm tired of the yo-yoing back and forth.  I've got so many differnet size clothes in my closet, it's not even funny. :)  I want to be able to get rid of my "fat clothes" and wear my "healthy me" clothes.

I thank you for your encouragement & I am so happy that WLS has helped you.  I appreciate what I've learned and gained from these boards.  BTW, I hope my post doesn't come across as hateful...that's not my intention at all. :)