Question:
How to get approved for the surgery

A frined of ours just had gastric banding surgery and is doing great. I have the same insurance coverage as he does. I am 125 pounds overweight with a 39 BMI Any suggestions how I can get my PCP to request this surgery for ms so it is covered under our insurance? Thanks    — Rhonda P. (posted on March 11, 2004)

March 10, 2004
First, do you need a referral from a PCP? The PPO types insurances do not requiure a referral, HMOs do. If you do not need one, then start calling surgeons for a consult - I would start with your friends surgeon. At the consult the office staff or coordinators will tell you exactly what you need to do to get approved - the process is different for each insurance company and the surgeons office will have experience in dealing with the different ins. companies. Good Luck.
   — Ali M

March 11, 2004
I would first check on your BMI again. I have been 5'9" tall since I was 14 years old and when I got measured for my insurance submission, I was 5'8 1/2" so that made my BMI go up to 40 instead of 38. If you are close like this, I would suggest rechecking your height. I was told that being overweight for many years may have contributed to the difference since I am not old enough (I think) for bone loss yet (I'm 34). Anyway, just something to think about. I was also told that the weigh in at the surgeon's office the first time is the one that counts so if you are close, what about not dieting until you see the surgeon and enjoying a few meals that you would have passed on because of their calories. I am not suggesting gaining a lot of weight but a couple of pounds would most likely bring you into the magic "40" number that is the standard for this surgery and approval by insurance companies. I don't want anyone to bash me for suggesting this so don't send me any emails on the subject. I did gain about 3 pounds when I indulged before seeing the surgeon and I am now 5 months postop and doing great. I have lost 75 pounds and have 44 more to go to be at my ideal weight. Good luck to you in your journey.
   — tntwildlife77