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5 year history

Lila21

By Lila21, in Insurance & Financing

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Lila21    36

Lila21
Posted

hey folks,

I am a newbie here, and I have a question about the 5 year history. I have UHC, and they require a 5 year history for approval. Do you have to have been at the BMI rate of over 35 during that time? I lost a lot of weight (approx. 100 lbs) about 6 years ago, and gradually regained most of it over the last five years. Am I going to be penalized for this? I think my weight was something like 175 6 years ago (5 year history starts 6 years ago, go figure), and I am now at almost 300. Any idea?

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NewMe2Bee    5

NewMe2Bee
Posted

hey folks,

I am a newbie here, and I have a question about the 5 year history. I have UHC, and they require a 5 year history for approval. Do you have to have been at the BMI rate of over 35 during that time? I lost a lot of weight (approx. 100 lbs) about 6 years ago, and gradually regained most of it over the last five years. Am I going to be penalized for this? I think my weight was something like 175 6 years ago (5 year history starts 6 years ago, go figure), and I am now at almost 300. Any idea?

Hello and welcome to the sleeve family,

5 year history sure sounds like a lot of data to gather. This is probably a determent so people will give up and not want to jump through all the hoops to get the surgery , that they will have to pay the cost to provide. The most that I have heard of with BC is 6 months, before I switched to Kaiser and was pursuing the lap band. BC wanted me to have 6 months of MD documentation to say that I was aggressively trying to lose weight with an nutritionist and medical doctor. The upside is that if you have been with the company for at least 5 years and have progress notes that your provider documented in the plan of care with obesity and/or overweight written in the context you should be okay. Good luck with everything and keeps us informed on your journey. You will find as you go through the post that everyone besides the out of pockets sleevers ( I assume) had to jump through some type of hoops in order to get approved through the insurance companies. If you are determined to to get the procedure and lose the weight you will do whatever it takes because this to shall pass....

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Lila21    36

Lila21
Posted

Hello and welcome to the sleeve family,

5 year history sure sounds like a lot of data to gather. This is probably a determent so people will give up and not want to jump through all the hoops to get the surgery , that they will have to pay the cost to provide. The most that I have heard of with BC is 6 months, before I switched to Kaiser and was pursuing the lap band. BC wanted me to have 6 months of MD documentation to say that I was aggressively trying to lose weight with an nutritionist and medical doctor. The upside is that if you have been with the company for at least 5 years and have progress notes that your provider documented in the plan of care with obesity and/or overweight written in the context you should be okay. Good luck with everything and keeps us informed on your journey. You will find as you go through the post that everyone besides the out of pockets sleevers ( I assume) had to jump through some type of hoops in order to get approved through the insurance companies. If you are determined to to get the procedure and lose the weight you will do whatever it takes because this to shall pass....

Thank you so much, NewMe2Bee! I was getting so anxious about that. Now I feel a little easier about just waiting it out and seeing what the insurance company says.

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Lila21    36

Lila21
Posted

Just wanted to let you know I got approved! Thank you for your supportive words!!!

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susieq    49

susieq
Posted

Lila, congrats!

UHC is also my insurer and wanted the five year documented weight history. While I've been to the doctor every year for five years, there were a couple of years that I refused to be weighed! I was really worried that this would count against me, but they approved me anyway. I'm pretty sure it was because my BMI was over 50.

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