Question:
I am 50 lbs overweight why do I not qualify for stapling?
My Dr refuses to help me get this done as he doesn't believe this is the answer. I have other medical problems that are exacerbated by being overweight. I am 50 years old. I'm not overly obese but I do know I would feel better physically & emotionally. I have BCBS insurance but unless a Dr were willing to write to the ins. co & word it correctly they would never grant permission. I have hit dead ends everywhere. I don't have the funds to pay for it myself so I guess I'm stuck. Anyone have any ideas on how to write a letter of request? — Diane S. (posted on April 29, 1999)
April 29, 1999
Obesity surgery is not for everyone. It is a drastic measure, used only
when everything else has failed, and used only in the case of morbid
obesity (100 lbs overweight). If you are 75 lbs overweight, and have other
problems (diabetes, hypertension, sleep apnea, to name a few), you might
qualify. According to Dr. Fobi, excessive weight of less than 69 lbs is
best controlled through diet and exercise. Obesity surgery changes your
life, and the life of those who live with you. It is a drastic step. Hope
this helps.
— Peggy51
April 29, 1999
Hi Diane-
From all the information on the internet and my doctor- the insurance
company and/or doctor or hospital will not due major sergry (i.e. stapling
the stomach) unless you fall into one of two ctagories- 1)obese with
serious medical complications or 2) 100 lbs overweight. If you would like
to try to convince your insurance and/or doctor about the necessity of this
operation check out the following web site and they have a sample letter
for you to edit and send to your providers. Hope this helps!
http://clos.net/sample_appeal_ltr.htm
-Paula
— Paula S.
April 29, 1999
50 LBS OVERWEIGHT- doesn't qualify for this operation. This operation is
for those that are at least 100 pounds overweight or more and have tried
all kinds of ways only to fail. You should glad that you do not qualify.
There are many agency that are able to help with losing 50 lbs.
— Sheila W.
April 30, 1999
I was "only" 80 lbs overweight, but BCBS paid for my surgery
because of my type 2 diabetes. I had mine at Mayo in Rochester MN. Don't
give up. Get a new doctor. If you have diseases cause by obesity, to deny
you surgery (which is the cure) is to deny you health. Would they deny a
cancer patient chemo?
— JAN C.
April 30, 1999
I was "only" 80 lbs overweight, but BCBS paid for my surgery
because of my type 2 diabetes. I had mine at Mayo in Rochester MN. Don't
give up. Get a new doctor. If you have diseases cause by obesity, to deny
you surgery (which is the cure) is to deny you health. Would they deny a
cancer patient chemo?
— JAN C.
April 30, 1999
You have to remember that weight loss surgery is a life
altering, drastic procedure. A last resort, if you will,
for those of us who are to a point where there is not other
alternative. At 50 pounds overweight I had other alternatives,
I just did not use them. You really need to try other
methods to lose your weight before considering this type of
surgery. I know for my own insurance it was required that I
be 100 plus overweight, have a certain BMI, be seen first by
three types of doctors including a psychiatrist and a
cardiologist, and have it proven medically necessary. It is
major surgery that you don't "want" to have if it can be
avoided.
— dboat
May 12, 1999
The reason why they want you to be heavier is because if you are too small
you may lose to much wieght. Check with other Dr.s because they all have
different regimens and requirements but most will say you are not heavy
enough.
— Donna D.
July 20, 2001
I know that it is frustrating to have any weight to lose and 50 lbs must
seem like a lot to you....BUT....try being 240 lbs overweight and fighting
with an insurance company to approve you for something that probably could
save your life. I wish I only had 50 lbs to lose...BUT...don't let it
balloon into more...go to Weight Watchers, Jenny Craig, LA Weight
Loss...any of them and get rid of it.
— [Anonymous]
July 21, 2001
Yes, all the previous posters are correct, 100 pounds overweight is the
rule for rny, ds, etc.....but now there is another option which you will
want to consider. And I understand that 50 pounds, when you have worked
all your life to get rid of it and have spent most of your life dieting, is
a HUGE problem and you deserve a thoughtful response to your question. As
for the person who suggested Jenny Craig, etc. GET REAL! you know diets
don't work. How angry did you get when people told you "just go on a
diet...or....just push yourself away from the table...or...(my favorite)
just eat the way I do! and you can lose the weight!" Yes, I managed
to maintain my weight at less than 100 pounds overweight for most of the
last 40 years...but I had to work damn hard at it every single day. I
counted every calorie, denied myself anything yummy, and exercised 2 hours
a day to do it. Was I less deserving of wls than those who were 300 pounds
overweight and never worked at being slim? I don't think so. I was very
disappointed to read the mean spirited and discriminating posts on this
question. How dare you sit in judgement of someone you don't even know.
— Anne G.
July 21, 2001
oops...I got angry and plum forgot to tell you about the alternative for
lighter people. My surgeon told me he is going to begin doing the new
adjustable band surgery laproscopically. He thinks this is a good
alternative for people with less than 100 pounds to lose who don't qualify
for the rny. It is also fully reversible. You will want to look into it.
I think I might have chosen this if it had been legal one year ago. Good
luck to you.
— Anne G.
July 21, 2001
I don't begrudge weight loss surgery to anyone .... if your weight is a
problem .... it's a problem .... whether it is 50 pounds or 500 pounds.
BUT .... I think it is also mean spirited to ASSUME that just because some
people are able to control their weight to a limited degree with diet and
exercise (ie keep themselves less than 100 lbs overweight).... that those
of us who had more to lose have never tried. I personally had over 200 to
lose .... went on my first medically supervised diet at the age of 7 and
tried many, many times since then. I have lost large amounts of weight on
numerous occasions, but have been unsuccessful in keeping the weight off.
I know there are many people, who like me, have large amounts of weight to
lose, but not becaue they have never tried. This comment is so typical of
the attitudes that society in general has against the overweight, the
obese, the morbidly obese and the super morbidly obese .... and I am
dismayed to see it on an obesity support site. I truly believe that
obesity is a DISEASE. Some people have a more severe form of the disease
than others .... but all who have the disease suffer. Please don't judge
us if you haven't walked in our shoes. We are all subjected to so much
prejudice and discrimination from society as a whole .... I hate to see
this type of comment from people who should know better.
— Lynn T.
July 22, 2001
I commend the previous two posters who actually took the time to understand
this persons question. 50 pounds is very close to 75 which is very close to
100 which is very close to 200. We ALL know how "one day" your
just there. I am proud of the person who says that they know they can get
there and they want to do something about it now. Shame on those who say
"honey you don't have a problem, I have a problem". We all have a
problem and thats why we are here. And we shouldn't have to post
anonymously so that we won't get bashed. What ever happened to the saying
" if you can't say something nice then don't say anything at all"
— [Anonymous]
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