I need you guys input on this matter

[RNY-Gal 40]

Let me know what you guys think of this. I have a BMI of 52.4 looks where it was say 45-55 BMI from what I get from it is I need either have one co-morbidity OR Do the 6 month diet. So now I'm told that isn't right. And that I need to have a co-morbidity AND do the 6 month

[Cervidae 2,389]

Looks to me that it's saying you either need co-morbidities or need proof of the 6-month diet, so I think you've got it right. I'm glad my insurance wasn't this way... my bmi was 66.9 when I started the approval process. I guess I would have been denied. D:

[RNY-Gal 40]

It is so frustrating.. My coordinator also pointed out that's how she she saw it too. But the insurance company said no, that the policy wasn't correct.

[James Marusek 5,244]

Looks to me that it's saying you either need co-morbidities or need proof of the 6-month diet, so I think you've got it right. I'm glad my insurance wasn't this way... my bmi was 66.9 when I started the approval process. I guess I would have been denied. D:

I agree, the policy states "either, or". So I agree with Cervidae.

But on the second point she made actually according to this policy if your BMI was greater than 55, none of those requirements apply. You are automatically qualified.

[Cervidae 2,389]

@@James Marusek I somehow completely missed that last bullet. I had no co-morbidities when I began the process but was approved quickly because of my high bmi. Blessing in disguise I guess? The bariatric team was sort of amazed at how healthy I was despite being 402 pounds. Life is strange.

[RNY-Gal 40]

I just spoke to my insurance company and the lady agreed with me it's either OR, not both. But she said she wanted to look into further and she was going to get back to me on it. She thinks the person my coordinator spoke to read the wrong one. Because there is different sections for different patients. People under 18, over 18 and revisions.

So, I don't know what to do now. My coordinator cancelled my Nut. Appointment. So if it comes back I was right the whole time I'll be a month behind. And won't see a surgery until August or September. :/

[sassyfrass23 525]

@@RNY-Gal is your insurance through you or someone else? Mine is with my husband's employer and we had a bit of a discrepancy in my policy. I ended up reaching out to my husband's HR department and asked for clarification as the insurance company (UHC) was zero help and my surgeon's office was a bit difficult in getting answers from. They just weren't taking it as seriously as I was. In the end- there was a verbiage error in my policy and it has worked out to my advantage luckily. The HR department went straight to their UHC rep to get the answers though. But I was grateful to have both of them working diligently to help me better understand what was expected of me.

And I CLEARLY read your policy as either or. Not both. It's actually written quite obviously. I don't see how your coordinator or the insurance company can misinterpret that?

Edited February 10, 2016 by sassyfrass23

[RNY-Gal 40]

@@RNY-Gal is your insurance through you or someone else? Mine is with my husband's employer and we had a bit of a discrepancy in my policy. I ended up reaching out to my husband's HR department and asked for clarification as the insurance company (UHC) was zero help and my surgeon's office was a bit difficult in getting answers from. They just weren't taking it as seriously as I was. In the end- there was a verbiage error in my policy and it has worked out to my advantage luckily. The HR department went straight to their UHC rep to get the answers though. But I was grateful to have both of them working diligently to help me better understand what was expected of me.

And I CLEARLY read your policy as either or. Not both. It's actually written quite obviously. I don't see how your coordinator or the insurance company can misinterpret that?

I have it through my employer. They recently just got this insurance (December 2015 UPMC) and my HR really don't know anything about it(go figure) she was actually trying to talk people out of getting it as she said "it's not worth it" but for me it is because it's the only insurance I've had in years that actually cover bariatric surgery.

Now I found another part of my policy that contradicts the other section which I posted.

 

Then here is the other part where I original got my information about what is required.

  

Edited February 10, 2016 by RNY-Gal