Newbie here

hey everyone. i am sceduled for a seminar on 5/15. im so exited. i am worried about the approval process. my BMI is hovering at 40. I have never been this heavy & im terrified if i dont get the help i need ( Lap band), that 1 year from now i will be over 300 lbs. I weighed close to 260 this morning. I am 5-8. I also have BCBS. I think i may have a problem providing a weight history. i think all my other dr appts for the past 15 yrs or so i was around 220 & below. I have been steadily gaining weight for the past 18 months since my son was born. i now weigh 15 lbs more than i did when he was born *sigh* i have missed dr appts ( stupid) because i was so ashamed. do anyone of you have any thoughts , ideas or suggestions?

Hi Melissa,

Welcome to the NC Forum of OH! I hope that you will find this to be a supportive and friendly and informational as I have. Please always feel free to ask questions and share your experiences ... it's how we all learn. You'll find that often when you post a question, others will let you know that they are so glad you asked.

Every insurer has their own criteria for approval and to be honest each policy that the insurer supports can vary, depending on the riders and exclusions that are associated with that policy. You may find that someone else here on the NC board has had your specific experience. You might also try 'cross posting' this to the Main and Insurance forums. You'll get more exposure there and may run across someone else with answers to your questions.

Some insurers will take non consecutive weights. Some will take less than 5 years documented. When you see the insurance person that supports the program you are considering ask them about the weight records and what their experience is with this issue.

You may have comorbidities that you do or do not know about that may make your under 40 bmi work. If you have one or more co-morbidities you'll probably qualify with a BMI of 35 or more. While my high BMI was around 43, my presurgery BMI was a little over 37; that was okay because I was diabetic, had high cholesterol and was diagnosed with sleep apnea. All of those are considered co-morbid conditions, so I didn't have to meet the 40 bmi threshold. From your note, it looks like your BMI has been around 33 until recently. Many times when it shows an overall upward trend they still consider it. The insurance specialist with your program can't give you a guarantee, but they can give you an educated guess as to whether you are likely to have any issues with the lower weights in the past.

When you are looking about gathering weights over the past 5 years remember to add in ALL dr appointments. Anything that might provide a record of your weight ... that could include your OB/GYN, ER trips for a sprain, etc...

Another possiblity is if you have gone to/through a supervised medical weight loss program or a supervised fitness program ... i.e., gym membership ... basically, you'd be looking for documentation from a 'recognized' disinterested 3rd party that would show your weight.

Wishing you a wonderous journey.

Barb

thanks Barb i didnt even know there was an insurance forum. i will go check it out. i have been doing a LOT of reading and saw where some people submitted weight info but not for consecutive years...an it worked for them. im hoping, as you say , that they will see the steady incline. i saw a doctor a few months ago for bronchitis(sp?).my weight then was 250. i think ive gained 7 or 8 lbs since then. so ill definately call her and my old ob/gyn. she should have my weight from my last checkup. i think it was in the 220's then. all my other checkups will not be that high. i guess  thats why im so scared. do they usually test people for these comorbiites? ( i read up on this too ). i didnt think i fell into any of the categories.  ill just cross my fingers & pray. i did a lot of thinking last night. im sure i could lose the weight on my own if i really focused and tried...BUT i know i would regain because i have a real passion for food. i just cant help it. thats why i sooooo want the lap band. its one thing to say --oh i can eat this-- ill be ok-like i do now.. but if i physically arent able to eat it( because of the lap band) ..my life would sooooo change. thanks so much for your input take care

Well.. I know of two weights that will help provide some help.. You can use your first prenatal and your 6wk checkup weights to help.. especially if you never lost all your pregnancy weight.  And any visits since will be helpful as well. Good luck to you as you start your journey!

Welcome to the NC board.   Barb answered your questions in detail so I don't have much to add.  You may just want to call BC on Monday and speak with someone to find out exactly what your policy covers and what, if any limitations it has on BMI. Good luck and take care, Pam

i called BCBS.. its like talking to a ROCK. they dont know what they are saying.all they could tell me is that they cover the surgery "if i am approved" and i will go thru that process with a doctor. thats all they would tell me arrrrrgh- i just dont want to go thru all of this only to get rejected. plus theres a  seminar i have to go to next thursday and i have to pay 200.00 just for that. i really cant afford it but i figured the end result would be OH SO WORTH IT. im so upset