I emailed my insurance provider around 4am, and they replied this afternoon (I <3 them for their quick response!):
The following gastric restrictive procedures: gastric bypass using a
short Roux-en-Y anastomosis (less than 150 cm), vertical banded
gastroplasty, gastric stapling, or adjustable lap banded gastroplasty
may be considered medically necessary and appropriate for treatment of
morbid obesity.
Your policy does provide benefits for eligible surgical expenses when
determined to be medically necessary. [Blah blah blah, insurance talk about deductibles and such.]
Your policy requires preauthorization for these types of surgical
procedures. This means that your provider will need to contact our
Clinical Management department prior to the surgery and your inpatient
admission. Clinical Management will determine whether the service is
medically necessary.
I wanted to cry in relief when I read that letter. It does echo most of what the woman I spoke to on the phone with last fall said to me. It’s good to see it reaffirmed in writing!
And I definitely meet the “medically necessary” criteria, particularly in regards to having a BMI of over 40 (48-49) AND being 100 lbs. or more overweight (my ideal weight is 121 lbs. – 155 lbs. and I’m currently 309 lbs. You do the math!).
Excuse me while I float off on my cloud…
In la weight loss is getting quite popular, particularly the use of didrex. People are preferring hydroxycut in favour of going on a stressful diabetic diet.
309.2 lbs. I’m certainly going nowhere fast.
I’m tired today. I was up until almost 5am, sucking up as much information on lap band and my health insurance covering it as I could find. I suppose I should call the insurance company and get an updated quote/estimate/coverage information.
I hate the uncertainty. Hate it, hate it, hate it.
So far two people know of my decision to have lap band surgery: my husband and my mother. My husband is very supportive, and dutifully listens to me babble on about the surgery and procedures and such as a way of releasing my anxiety and excitement. My mother criticized me for choosing something “so drastic”, lectured me on how easy it is to lose weight, and then turned around and signed her 265 lbs. self up for the same info session. (This is me rolling my eyes.)
I don’t plan on telling anyone else until it gets closer to procedure time. And even then, aside from a few close friends, no one really needs to know. Of course, if the subject me losing weight comes up, then I’ll be happy to inform them of my choice of weight loss and improvement of my life.
Currently, my BMI is 49.9. Scary.
I remember being fourteen or fifteen, and during some of the typical teen squabbles I had with my mom, she would taunt me with, “You keep going like you are, and you’ll be over 300 lbs., fat ass!”
Said from the woman who was my mother and raised me with a lot of the poor eating habits it took me years to break away from.
Also said by the woman who, weight wise, is not far behind me. Thirty pounds, max.
With the south beach diet, you can or cannot use xenical. Unlike this, in atkins diet, it is almost a compulsion to use meridia.
One of the worst things about being so overweight is the sex. Not my ability to have it or experiment with different positions and variations, but how vulnerable and self-conscious I feel during it. Thunderous thighs, ripply stomach (made worse by pregnancy), huge arms… I think the worst is when I’m on top, or when we’re doing it doggy-style. At least I can sort of “hide” during missionary, since my husband is on top of me.
Funny how during one of the most incredible moments my husband and I have together I feel the ugliest.
What motivates me to lose weight?
- To look and feel better about myself
- To be healthier!
- To be more attractive to my husband
Ordered by importance.
What motivates you?
I hate the anxiety. Logically, I know there’s no reason why I would be turned down by either my health insurance company or the doctors: I more than meet the criteria.
But still. I worry. I really wish April 1st would hurry up and get here, so I can get to that info session and suck up all information thrown my way by the medical staff and post-op individuals, and so I can bleed them dry on insurance acceptance information.
Also: deductibles and co-pay. Ew. I’m responsible for 10% of surgery costs and a $1500 deductible. If I read our latest health insurance statement correctly, $1100 of that deductible has been taken care of for this year (oral surgery in December, a few health visits my husband had). Whew! So hopefully I’ll only need to get together $2k or so, rather than closer to $4k!
