AquariusDiva

Unfortunately, I was denied bc my bmi fell below 35 one year during my 5 year weight history ... It really depends on your insurance and the requirements

First read what your insurance requires. I have United Healthcare, have a BMI of 39, high blood pressure, apnea, and pre diabetes. I got my PCP to write the letter after a 6 month supervised diet, but was just recently denied because of the 5 year history requirement. One year it fell below 35 BMI and I'm missing another year 2011. So my dr is going to try peer to peer review - and I sent in pictures since 2006 (wedding) to now to show that while I did manage to loose weight one year, the problem is maintaining it. I am thinking of switching insurance to DHs company, gaining 10 lbs to push over the 40 Bmi since the new insurance doesn't require a 5 year history.

I would called the doctors office and ask for them to reschedule to be on the safe side. Otherwise, call the new insurance and start the approval process - confirm that they cover it, that you qualify, that the dr is in network, etc. My understanding is that the new insurance will be the one that will have to pay.

I have United and I am having to do the 5 year weight history as well as the 6 month nutrition sessions. So now I have to get started on the paperwork in which will be tricky since I recently moved and I have no PCP, and I need to get my old PCP to fill out the 5 year weight history. ANd I need to get a new PCP or someobody to do the 6 month diet. I saw a dr. last month but when I mentioned the 6 month diet requirement he basically told me they had no nutritionist in the group (which to me means he didnt want to do it). On top my UHC is lagging on confirmation of what I need to do. One person told me to call the Bariatric Resources, when I did that person told me that they do not handle my particular pland. Called United back and they confirmed (again) that Bariatric didnt handle the process. They did say it was covered. But they have escalated it. I started that inquiry a month ago and it is still "in process".

We are considering Dr. Roslyn at Lenox Hospital ..,

I am also just a couple of pounds shy of hitting 40 BMI, I do have high blood pressure, but I don't want to risk it , so I am eating 3 meals plus dessert all this week until my weight in.

I was curious as well. I am just starting doing research for WLS after a lifetime of being overweight. Right now I am going back and forth between which insurance will be best to use for WLS for both DH and I. Both insurance cover it, United Healthcare and Cigna, but I have heard that Cigna is easier. That is not a problem for DH who has a BMI of 41, diabetes, high cholesterol, and severe sleep apnea so he would easily quailty under both insurances. I am right now closer to 39 - 39.5 BMI. And during the past 5 years, have generally been around 37-38. Lowest was 35.2 and that lasted about a month. Only have one co-morbibidty of high cholesterol for the last 4 years. I snore loudly, so I am hoping to have a sleep test and see if I also qualify for at least mild sleep apnea. But overall, I dont want to loose the chance - so I am considering adding a few pounds (about 5) and making sure my BMI is over 40. DH and I have a seminar and first consult next week.

I can't seem to join the low Bmi support group :/ I am 5'6", currently 240, 38.7 BMI I called my PCP office and figured out I was 245 5 years ago. , so 39.5. My weight has been usually in the 230s during that span. I currently have high blood pressure and that began with my sons pregnancy 4 years ago. So I am not sure if my insurance will cover WLS for me.

Thanks! The United Healthcare has more stringent requirements than Cigna. Cigna would not require a 6 month wait/diet. Others in DH's company have recently undergone the surgery and the approval process was very easy (for them at least). I guess, I just wanted some help deciding wehther spending about $2,000 more is worth going with Cigna? Yes, we can afford the extra $2,000, but it is still money that we need to allocate. I am leaning towards Cigna.

It is open season at my work and at my husbands work. Both insurances and worker plans cover weight loss surgery. The UHC plan description is pretty clear as to the requirements for WLS are, Cigna not as much, but they do cover at over 40 BMI or 35+ BMI with comorbidites.. The costs are slightly higher for Cigna, 80% copay (Cigna) versus 90% copay (UHC) after the deductible. Any insurance gurus out there? If you had to choose, which one would you go with?