<p>my insurance company ( aetna choice ppo II) requires you to have proof that you have been 40+ bmi for at least five years. i have been for over five years but being that i was never really sick and didn't have insurance till three years ago i never went to the doctor. so i dont have the documentation to prove this. i just now got a pcp. what should i do?? will they not cover me because if this?</p>

I have the same problem. I would always get a prescription over the phone so I am not sure if they will or won't. If I get the answer to the question I will let you know.

Got sick of Horizon for the same thing and self-paid. I go to the doctor so rarely I couldn't prove anything. They are being fairly good about paying after the fact though *knock on wood*. Not that I suggest that strategy though. They haven't paid doctor or hospital bill yet, but they did pay for the first fill (100%) and for the surgery anesthesiologist bill at 50% (better than nothing).

They will deny you without the weight history, its another way that they get over they know a lot of obese people do not go to the Dr. If you have your OB-GYN records they will take them, But I had the same problems and Had to contact emergency room hospitals, and my OB-GYN office to get the records

I have a question. What if you can prove in 98,99,02,03,05,06,07,08 you have been morbietly obese will they still approve you if you are missing one year? I am sure I can find one Dr. that I went to that year but this is what I have proof of right now? Does anyone know if it has to be five straight years?

Flowerpurr- Common sense would say "Yes" especially since I'm assuming your weight history will show a continual increase each year. But you never know when dealing with insurance companites!

They will deny you without the weight history, its another way that they get over they know a lot of obese people do not go to the Dr. If you have your OB-GYN records they will take them, But I had the same problems and Had to contact emergency room hospitals, and my OB-GYN office to get the records

You lucked up! I went to the ER today and picked up my records only to find that --- They have record of me being there but they did not put my weight on there!! I am sooo mad!!!:cursing:

They will deny you without the weight history, its another way that they get over they know a lot of obese people do not go to the Dr. If you have your OB-GYN records they will take them, But I had the same problems and Had to contact emergency room hospitals, and my OB-GYN office to get the records

Hi I live in fort worth as well and I am a African American female trying to get the lapband procedure. I am not sure what documents they are looking for. How did you get you five year history? I have done weight watchers, herbalife, FIG, medifast and all but I am not sure they will take this kind of documentation?? Can you give me any advice to get approved. savardasnell@hotmail.com

I would reccomend finding any doctor you have been to where they had you step on a scale. Also, all weight watchers records would definitely help.

The goal is to prove that you've been obese for a very long time and diets do not help. If you have the records you'll find success in the appeal process. Things that will also help, if you have your doctors write letters to the appeals board.

Good Luck

Hi I live in fort worth as well and I am a African American female trying to get the lapband procedure. I am not sure what documents they are looking for. How did you get you five year history? I have done weight watchers, herbalife, FIG, medifast and all but I am not sure they will take this kind of documentation?? Can you give me any advice to get approved. savardasnell@hotmail.com

I emailed you, who are you going with to get approved? I highly recommend lapband solution they did all the insurance stuff and appointment and paperwork for me all I had to do is show up they got me approved in 2 weeks

Is this the same problem if self-paying? Is it necessary to prove that I have been on a weight loss plan with my doctor when paying cash for the procedure?

no the weight history is for the insurance company if you are self payer no insurance hoops to jump....good for y:thumbup:ou