5 yr. medical history of obesity?

CheriCline · November 6, 2006

:cry I talked to my insurance company and they gave me their website address to look at regarding obesity. It says that I have to have a 5 year medically documented history of obesity. I have been overweight my whole life, but just recently crossed over the 40 B.M.I. threhold. I am 5'7 and weigh 275. Has anyone else heard about this 5 year history of medical documentation that is needed? What if I don't have that? Am I not going to get approved? Am I wasting my time? :cry Any advice and help would be greatly appreciated..........

GayleTX · November 6, 2006

That seems to be a pretty common requirement. BCBS required that of me. They accepted my dr's records that showed my weigh-in weight for office calls. I also had to fill out a form giving an overview of my weight loss attempts in my life time. The most difficult thing to document was medically supervised weight loss attempts for a 5 year period. Every doctor I ever saw mentioned my weight but very few wrote any suggestions it in their notes. I was told they would not approve me because of that one deficiency but I wrote a letter of appeal and was then approved.

CheriCline · November 6, 2006

Thank you so much for replying so quickly. I have mentioned my weight to my doc too but I am sure there is not documentation of it. Like I said I just now crossed over to be "concidered obeses" even though I have always been way too heavy. So you found that with BCBS you had to be medically supervised for weight for a 5 year period??? Can you send me a copy of the appeal letter you wrote for my future reference? chericline@hotmail.com. I would greatly appreciate it. I can tell I am going to have a hard fight ahead of me. Please keep me in your prayers. Congrats on your weight loss...Anyone else have any other suggestions about the 5 year history of medically documented weight loss?

5jacks · November 6, 2006

My insurance (Aetna) also requires 5 years of "proof". I also threw a fit when being weighed at the Dr.'s offices, boy am I glad now that most of the time they didn't listen to me! I had to go back to 1999 and get OB/GYN records showing weight and then there was a couple of years with no visit to any doctor (no lectures, I'm going on a yearly basis now!!). Anyway, found enough information and the appeal was sent in on Thursday.....my fingers are crossed! Good luck with your fight, I know it's frustrating but beleive it will all be worth it in the end!

Alexandra · November 6, 2006

CheriCline, the 5-year history is not an uncommon requirement at all. It doesn't mean 5-year medically supervised diet attempts; all it means is that you need to show you've been obese for at least five years. Insurance carriers must use yardsticks to decide who qualifies for bariatic surgery, and that is one of them. There are so many people who are morbidly obese, the thinking is that people who have been that way longer are the ones who will most benefits from medical intervention.

If you've visited any doctor in the last five years who might have made a note of your weight, call that doctor and get the notes. They're just looking for evidence of the weight, not necessarily evidence that you were trying to lose it. I called my OB/GYN and got her notes from the years in which I had my children. No discussion of weight loss, but lots of evidence of excess weight before and between pregnancies.