Question:
Obese & Disabled - Anyone ever had Lapband done?

I started doing research online for the Lapband procedure. I have CRSD (Chronic Reflex Sympathetic Dystrophy) and I am totally disabled. Therefore, exercising is not possible. The disease started in my left foot/leg and then spread over to the right foot/leg. About three years ago, it finally spread throughout the rest of my body. I have a Spinal Cord Stimulator in my back and a Morphine Pump in my stomach for pain. However, the Morphine Pump is implanted on the right hand side of my belly button. It is located just underneath in a pocket of skin. I have gained over 80 lbs since this happened to me and my weight continues to go up. I have tried various diet programs but have only been able to lose maybe 5 lbs. and then another 10 or so come back on with it. Since I am only 5 4", at 225 lbs., my BMI is at 38.6. That puts me in the Obese category. I have enough health problems already however I am setting myself up for diabetes & high blood pressure. I really need to do something about this soon. I have Medicare as my Primary carrier and then Aetna as my seconday insurance. Is anyone else Disabled & Obese? Does Medicare cover this procedure? If so, did you have to go through any red tape to get it approved? If so and you had the procedure done, please elaborate on how your experience was with the lap band - before (were you well prepared?), during, and after (did they explain everything that needed to be done from here on out?) Did you loose weight? How much per week, per month? I really appreciate any help you can give me. Regards, Palarin    — Marie R. (posted on March 11, 2007)

March 11, 2007
Before you even worry about insurance you need to go to a Lap-Band seminar and tell tehm your healt situation and see if they will even do it to begin with. I know my insurance won't touch my husband for his lap band if his BMI is under 40.
   — Lost4Ever

March 12, 2007
I'm obese and disabled. I've got back trouble to, but I didn't want that pump. Gained weight anyway. Yes here in KY medicare now covers lap band, but they have to have certified hospitals. I'm scheduled to see the surgeon on March 28. there is alot of red tape to any insurance, but I'm willing to take the steps. Back pain only gets worse with weight.
   — lbutts

March 13, 2007
Just so people know: according to the medical "powers that be," obesity starts at a BMI of 30. Morbid obesity starts at a BMI of 35. Yet one ordinarily qualifies for weight-loss surgery at a BMI of 40--by what logic, if a 35 BMI is "morbid," I don't know. A BMI of 35 will qualify one for surgery if one is deemed to have weight-related "comorbidities." And some surgeons will accept lower BMI's for the Lap-Band than for more aggressive surgeries such as the RNY and the BPD/DS. On the other hand, some insurers won't cover the Lap-Band at all. Keep in mind that an inability to exercise will blunt the success of a purely restrictive surgery such as the Lap-Band.
   — Virginia N.

March 13, 2007
I am on disability and I am obese. I just had the lapband done on Dec 4th 2006. There was no red tape. Medicare will cover the procedure provided it is done by a Dr that is certified as a Center of Excellence. You can find out if a surgeon has this certification here on OH.com. Just click on find a bariatric surgeon and check to see if he has this center of excellence certification. I also have Diabetes and high blood pressure and diabetic nerve damage from the Diabetes. Medicare covered it without any question. You can always call them to ease your mind in your case. I was weighed today and have lost 60 lbs since I started preparing for the surgery. You do lose a lot of weight with the prep prior to the surgery. You would have to speak with a Dr about not being able to exercise. I'm sure they can find some way you can do it because it is crucial to success. Best of luck. Dan
   — bigdooba

March 13, 2007
Thanks everyone for your input. After posting this, I found out that Medicare does cover it with the stipulations that Dan mentioned. I also spoke with Aetna and they will cover it too. Dan, what kind of exercise are you able to do? The problem I have is that I can only take a few steps & then my pain kicks into overdrive and I have to sit down. That is why I am using an electric scooter at home and a wheelchair when I go out. Since I became totally disabled with this disease, I can't do hardly anything, let alone exercise. However, my pain doctor said that the only other thing I can try would be maybe an aerobic water class which I am willing to do. If this can give me some activity back in my life, then it would make me so very happy because I also deal with depression due to my disease. Lydia - It sounds like you & I may be at the beginning of this process. Please keep in touch with me to let me know how you are doing and I will do the same. God Bless Everyone! Marie
   — Marie R.

March 15, 2007
Here are a couple thoughts for you... Before having this surgery, talk it over with your pain management doc. Depending on what meds you are one and how much, you may need different meds/amounts that are used normally. There is also the potential that the crps could get worse due to the "trauma" of surgery. As far as exercise... aqua-aerobics are great. Recumbent stationary biking, swimming, hand pedals... you don't have to run a marathon the first day :) If you can use a manual wheelchair or walker or something like that, go for it. Taking 4 steps with a walker is more exercise than nothing at all. Wheel yourself for 10 feet.... etc. You might always want to look on the net for exercise tapes meant for someone who is in a wheelchair or just unable to stand up for the length of a session. If you have sometime, would you mind emailing me? I have not had WLS yet (and maybe not ever, as i have a lot of weight due to illness.... but I'm trying to decide what my next step is (i have rsd/crps)... pump or spinal cord stimulator.... and if you wouldn't mind sharing, I would very much like to hear about your experience.
   — mrsidknee

March 26, 2007
I agree that you need to consult your docs about their opinions regarding whether you can tolerate surgery, etc. If your insurance does cover the procedure and they still turn you down, do go through the hoops to appeal any negative response. Although I am not any kind of expert about how Medicare works, I did just have a conversation with a woman who had a friend who had just had lapband surgery. If I am reporting this correctly, the friend was so distressed because Medicare in Washington State evidently no longer covers banding. Oregon Medicare does cover it. She was somehow able to switch to surgery in Portland, OR (just over the WA line), were she ended up paying appx. $300 out of pocket. It sounds strange that a federal program such as Medicare would vary state-to-state, but it does. I paid out of pocket for my lapband, and have no regrets. I started at about 260, and have lost appx. 35 lbs in six months, and I am embarrassed to say that that is without any exercise. I am a teacher, so I am moving around during the day, but that is about the extend of it. I know that my weightloss would go faster with exercise, and it is right up there on my list... ;-) Good luck to you!
   — karentherese

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