One more newbie - ThinnerTimes

sweetone · 05-11-2007, 06:37 PM

Hi everyone, First of all I have been lurking here for 2 years and Thank God for all your posts and the incredible hope and inspiration your stories provide. I have gotten so much good information here and appreciate your honesty and willingness to share your stories. Now as I begin my journey in earnest, I hope I can become a part of this group. I am in the beginning stages of trying to get approval from Pacificare HMO (SCMG), and am confused about the whole process,whether to get lapband or GB,and the necessity for a 6 month medically supervised diet.(Seems pretty dumb since I've tried everything and am larger than ever!)My insurance also requires 6 months of healthy roads which I have been unable to find much info about. I understand there is no way around this but my dilemma is that I don't know what is acceptable to lose. Sounds ridiculous! I have a BMI of 41 and no comorbitities , though possibly can use joint pain and sleep apnea. I have been told that I must lose weight or will be considered noncompliant. Also know I cannot lose more than 10 lbs or so in the 6 months and retain my 40 bmi, which is required to qualify for the surgury.I have an appointment in 2 weeks to see dietician and hope this will answer some of these questions. In the meantime I am obsessing on this whole process, want the surgury yesterday,and trying to just let go and relax a bit. I know from the posts here the approval process is rarely quick, or easy. I guess I just want to introduce myself and take that one more step forward in the right direction.Thanks for listening, and thanks again for being here.

VanessaSFL · 05-11-2007, 06:39 PM

Well after two years you probably already know most of us

Welcome to the group!

V

Gina in NY · 05-11-2007, 06:52 PM

Quote:

Originally Posted by sweetone

Hi everyone, First of all I have been lurking here for 2 years and Thank God for all your posts and the incredible hope and inspiration your stories provide. I have gotten so much good information here and appreciate your honesty and willingness to share your stories. Now as I begin my journey in earnest, I hope I can become a part of this group. I am in the beginning stages of trying to get approval from Pacificare HMO (SCMG), and am confused about the whole process,whether to get lapband or GB,and the necessity for a 6 month medically supervised diet.(Seems pretty dumb since I've tried everything and am larger than ever!)My insurance also requires 6 months of healthy roads which I have been unable to find much info about. I understand there is no way around this but my dilemma is that I don't know what is acceptable to lose. Sounds ridiculous! I have a BMI of 41 and no comorbitities , though possibly can use joint pain and sleep apnea. I have been told that I must lose weight or will be considered noncompliant. Also know I cannot lose more than 10 lbs or so in the 6 months and retain my 40 bmi, which is required to qualify for the surgury.I have an appointment in 2 weeks to see dietician and hope this will answer some of these questions. In the meantime I am obsessing on this whole process, want the surgury yesterday,and trying to just let go and relax a bit. I know from the posts here the approval process is rarely quick, or easy. I guess I just want to introduce myself and take that one more step forward in the right direction.Thanks for listening, and thanks again for being here.

I don't think they count your weight loss pre-op against you - in other words, if you started out at a BMI of 40 and lose enough weight to get to 36, they still start you at the 40 - but check with your doctor. That is what mine said.

The decision for lap or GBP - search the topic - it is very individual. You have to know your level of discipline, expectation etc.

Good Luck.

Haveaball · 05-12-2007, 04:31 AM

Welcome to TT!!!
I agree with Gina, usually the insurance goes by the beginning bmi, so no worries there. IMO, your very first step is to see if your insurance will cover gbp or lap band. Some go through the whole process to find out their insurance has a "direct exclusion" on their policy. The first phone call should be to your insurance company.
Good luck to you, and again, welcome!

sweetone · 05-12-2007, 08:22 AM

Thank you for your responses. I know my insurance will cover this, but have not got a direct answer from anyone yet regarding weightloss. I just asked the surgeons office administrator who has been very helpful with every thing else over the telephone. I am hoping all my questions will be answered when we meet in the next few weeks. I am so glad I called my insurance tho because they recently added a requirement to do 6 mo Healthy Roads program and 6 mo supervised diet. Fun! At least I will be able to do them simultaneously. My surgeons office and my PCP did not know about this until I called directly, even though surgeons office had a recent list of requirements from my insurance co it was not on there. Must have just added it.lucky me. Does anyone know what healthy roads is? Thanks