Where do I start? - ThinnerTimes - Gastric Bypass Forum, Lap Band Forum, and Vertical Sleeve Gastrectomy Forum

glocks90 · 04-07-2009, 09:11 AM

Hello everyone I am new, I have been thinking about the lap band ever since my brother worked for inamed, and he told me about it. I am 100 lbs over weight and have been chubby forever. I just started going to a new pcp and he doesn't agree with surgery, great. Said diet and excersize is all I need, well i have been dieting my whole life and it hasn't worked. I have Health net HMO and they cover it if I meet all the criteria. My husband says we just can't afford to pay out of pocket, I have signed up on what seems like every lap band website no reply. I don't know where to start. Do I have to shop around for a PCP that will help me? What do I do next?

GTR-Mark · 04-07-2009, 09:14 AM

Quote:

Originally Posted by glocks90

Hello everyone I am new, I have been thinking about the lap band ever since my brother worked for inamed, and he told me about it. I am 100 lbs over weight and have been chubby forever. I just started going to a new pcp and he doesn't agree with surgery, great. Said diet and excersize is all I need, well i have been dieting my whole life and it hasn't worked. I have Health net HMO and they cover it if I meet all the criteria. My husband says we just can't afford to pay out of pocket, I have signed up on what seems like every lap band website no reply. I don't know where to start. Do I have to shop around for a PCP that will help me? What do I do next?

It seems having a PCP's support is helpful in the process. I'm not sure it is required. Looking into the future, I would want a PCP that supported my decision as they help manage my overall health.

Native2u · 04-07-2009, 09:20 AM

Yeah, if that is what you want to do and your PCP doesn't support you......next! Find someone that supports WLS and start from there.

When you call to make an appt with a "new" doctor, you have every right to ask if he supports WLS (weight loss surgery). If they don't answer you......move on to the next one.

lillylaroo · 04-07-2009, 09:21 AM

I wasn't sure where to start either but I suggest looking up a Weight Loss surgeon in your area. That's their business so they should be able to direct you on what needs to be done.
I called up a clinic in my town and gave them my insurance info. After they verified my insurance they sent me a packet that explained the different WLS options and what the insurance required. They could probably direct you to a PCP that will support your decision. My insurance required a 6 month PCP monitored diet, a meeting with a dietician, psych evaluation, and blood work. The surgeon will submit the request to the insurance for approval.

watfam4 · 04-07-2009, 09:23 AM

I'd start with doing a lot of research to find out what your options are and what your insurance will cover before you start shopping for a new PCP.

lillylaroo · 04-07-2009, 09:25 AM

And one more thing........If you go through with the surgery you will find tons of support and always someone there to listen at this site. I joined in March but wish I would have found this place when I first started my requirements.
Good Luck to you......

watfam4 · 04-07-2009, 09:26 AM

Quote:

Originally Posted by lillylaroo

I wasn't sure where to start either but I suggest looking up a Weight Loss surgeon in your area. That's their business so they should be able to direct you on what needs to be done.
I called up a clinic in my town and gave them my insurance info. After they verified my insurance they sent me a packet that explained the different WLS options and what the insurance required. They could probably direct you to a PCP that will support your decision. My insurance required a 6 month PCP monitored diet, a meeting with a dietician, psych evaluation, and blood work. The surgeon will submit the request to the insurance for approval.

Most also require a minimum BMI and/or documented co-morbidities.

lillylaroo · 04-07-2009, 09:30 AM

Quote:

Originally Posted by watfam4

Most also require a minimum BMI and/or documented co-morbidities.

That too......

glocks90 · 04-07-2009, 09:48 AM

I definatly have a high bmi which meet the criteria, however, I don't have any of the other criteria besides, loud snoring and foot pain if I am on them too much. but I do have family history of heart disease and colesterol not sure if that helps.

lillylaroo · 04-07-2009, 09:56 AM

Quote:

Originally Posted by glocks90

I definatly have a high bmi which meet the criteria, however, I don't have any of the other criteria besides, loud snoring and foot pain if I am on them too much. but I do have family history of heart disease and colesterol not sure if that helps.

If your BMI is over 40 that usually is enough. I have acid reflux and muscle/joint pain from all this weight. That's it. The surgeon tells me my BMI is enough but we will see how easy I get approved by the insurance. I would hope that I could trust the surgeon's opinion.