Ok so my insurance denied me because my BMI was only over 40 for 3/5 years! How can I appeal this??? My plan states that it must be over 40 for 5 years in a row.

Talk to your bariatric team. Usually they have a medical coordinator who can work with you on appeal. Additionally if you have any other health issues that are impacted due to excess weight, have that thoroughly documented.

Well what insurance do you have? I have Aetna and they want only 2 years. There has to be a loop hole.

Here is what they require if you have Aetna.

Must meet either 1 (adults) or 2 (adolescents):

1. For adults aged 18 years or older, presence of persistent severe obesity, documented in contemporaneous clinical records, defined as any of the following:

   1. Body mass index (BMI) (see appendix) exceeding 40; or

   2. BMI greater than 35 in conjunction with any of the following severe co-morbidities:

      1. Clinically significant obstructive sleep apnea (i.e., person meets the criteria for treatment of obstructive sleep apnea set forth in CPB 0004 - Obstructive Sleep Apnea in Adults); or
      2. Coronary heart disease, with objective documentation (by exercise stress test, radionuclide stress test, pharmacologic stress test, stress echocardiography, CT angiography, coronary angiography, heart failure or prior myocardial infarction); or
      3. Medically refractory hypertension (blood pressure greater than 140 mmHg systolic and/or 90 mmHg diastolic despite concurrent use of 3 anti-hypertensive agents of different classes); or
      4. Type 2 diabetes mellitus
         

Well what insurance do you have? I have Aetna and they want only 2 years. There has to be a loop hole.

Here is what they require if you have Aetna.

Must meet either 1 (adults) or 2 (adolescents):

1. For adults aged 18 years or older, presence of persistent severe obesity, documented in contemporaneous clinical records, defined as any of the following:

   1. Body mass index (BMI) (see appendix) exceeding 40; or

   2. BMI greater than 35 in conjunction with any of the following severe co-morbidities:

      1. Clinically significant obstructive sleep apnea (i.e., person meets the criteria for treatment of obstructive sleep apnea set forth in CPB 0004 - Obstructive Sleep Apnea in Adults); or
      2. Coronary heart disease, with objective documentation (by exercise stress test, radionuclide stress test, pharmacologic stress test, stress echocardiography, CT angiography, coronary angiography, heart failure or prior myocardial infarction); or
      3. Medically refractory hypertension (blood pressure greater than 140 mmHg systolic and/or 90 mmHg diastolic despite concurrent use of 3 anti-hypertensive agents of different classes); or
      4. Type 2 diabetes mellitus
         

Well what insurance do you have? I have Aetna and they want only 2 years. There has to be a loop hole.

Here is what they require if you have Aetna.

Must meet either 1 (adults) or 2 (adolescents):

• For adults aged 18 years or older, presence of persistent severe obesity, documented in contemporaneous clinical records, defined as any of the following:

• Body mass index (BMI) (see appendix) exceeding 40; or

• BMI greater than 35 in conjunction with any of the following severe co-morbidities:

• Clinically significant obstructive sleep apnea (i.e., person meets the criteria for treatment of obstructive sleep apnea set forth in CPB 0004 - Obstructive Sleep Apnea in Adults); or
• Coronary heart disease, with objective documentation (by exercise stress test, radionuclide stress test, pharmacologic stress test, stress echocardiography, CT angiography, coronary angiography, heart failure or prior myocardial infarction); or
• Medically refractory hypertension (blood pressure greater than 140 mmHg systolic and/or 90 mmHg diastolic despite concurrent use of 3 anti-hypertensive agents of different classes); or
• Type 2 diabetes mellitus

I have United Healthcare... My dr is suppose to do a peer to peer with the insurance company

Any word from your insurance company? @@Chylyn7

Any word from your insurance company? @@Chylyn7

Any word from your insurance company? @@Chylyn7

Any word from your insurance company? @@Chylyn7

My dr office missed the phone call for the peer to peer review last Friday. So it's rescheduled for 9/25... I've been in contact with HR they said if they deny me again to contact them. My company is self funded so they will most likely approve my surgery