Insurance pre-approval; 5 year weight history???

[trinitysleeve 1]

Hi everyone,
I have a pre-surgical question; has anyone had their insurance company request weight records from your Dr. for the past 5 years? I’ve heard of people getting their surgeries denied because they do not meet weight requirements for the past 5 years.
This worries me as I haven’t been submitted for insurance approval yet, but if my insurance company requests 5 years, I may have an issue. I am considered low on the BMI scale (35), however, with my heart attack last year, high BP, high cholesterol, etc., my surgeon says I meet the requirements. I hope I’m not stressing myself out before I even get to the pre-approval process.

Thanks everyone!

[Healthy_life2 8,319]

28 minutes ago, trinitysleeve said:

Hi everyone,
I have a pre-surgical question; has anyone had their insurance company request weight records from your Dr. for the past 5 years? I’ve heard of people getting their surgeries denied because they do not meet weight requirements for the past 5 years.
This worries me as I haven’t been submitted for insurance approval yet, but if my insurance company requests 5 years, I may have an issue. I am considered low on the BMI scale (35), however, with my heart attack last year, high BP, high cholesterol, etc., my surgeon says I meet the requirements. I hope I’m not stressing myself out before I even get to the pre-approval process.

Thanks everyone!

Is it to prove you have been overweight for five years?

[HipHopDiva 220]

1 hour ago, trinitysleeve said:

Hi everyone,
I have a pre-surgical question; has anyone had their insurance company request weight records from your Dr. for the past 5 years? I’ve heard of people getting their surgeries denied because they do not meet weight requirements for the past 5 years.
This worries me as I haven’t been submitted for insurance approval yet, but if my insurance company requests 5 years, I may have an issue. I am considered low on the BMI scale (35), however, with my heart attack last year, high BP, high cholesterol, etc., my surgeon says I meet the requirements. I hope I’m not stressing myself out before I even get to the pre-approval process.

Thanks everyone!

I though the same thing because I only became obese due to a slip and fall accident in 2017. I gained over 60 pounds, which took me over 35 bmi and I developed severe arthritis and degenerative disc problems in my lower back. These Comorbidities quantified me for surgery. If your approval documents were submitted by your primary care doctor, you have a bmi of 35 with 2 Commodities - I wouldn't worry. Just go through your insurance process to complete final approval : )

[trinitysleeve 1]

Thanks!

[trinitysleeve 1]

On 08/16/2019 at 14:12, Healthy_life2 said:

Is it to prove you have been overweight for five years?

I haven’t been through the insurance pre approval process yet, but someone else has and her insurance denied her surgery after here PCP sent in her 5 year weight history. Apparently she didn’t meet the insurance company’s threshold for being “obese” for 5 years.

[GradyCat 3,692]

I'm not aware of my insurance company asking for a 5 year weight history and I was approved.

[RickM 1,747]

Take a close look at the policy bulletin regarding WLS on the insurance company's website and see what it says - it should spell out exactly what their requirement is. If need be, enlist the help or your surgeon's insurance coordinator as they speak that language. That is their legal document and is what they can be held to - not what someone else's insurance company does. If they want you to have been over a certain BMI number for five years, then they have to spell that out in that document.

Such requirements can be waived if you (or more specifically, your doctors) can make the case with them that your health history makes the surgery a medical necessity, irrespective your weight history. This would usually happen after they deny you and you file an appeal. Your state insurance regulator can also order them to provide coverage if they find the requirement to be unreasonable in general or in your specific case.

Don't get too far ahead of yourself here, and take it one step at a time. Good luck.

[PeachPerfect 13]

I think the surgeons confidence is a good sign. Hope it all works out for the best!

[ypease 177]

I can see why they would. But I would agree with comorbidities comment. Most, pcp's know how to submit the request to ensure approvals. I am self pay, both a blessing and a curse. However, if my insurance company wanted a history of my weight, they better pack a lunch and bring a flash light because they're going to be there a while.

[Deedee12 1,859]

I can see why they would. But I would agree with comorbidities comment. Most, pcp's know how to submit the request to ensure approvals. I am self pay, both a blessing and a curse. However, if my insurance company wanted a history of my weight, they better pack a lunch and bring a flash light because they're going to be there a while.

Lol!!!![emoji23][emoji23]

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[weightlossjourney2020 0]

Hi everyone,
I have a pre-surgical question; has anyone had their insurance company request weight records from your Dr. for the past 5 years? I’ve heard of people getting their surgeries denied because they do not meet weight requirements for the past 5 years.
This worries me as I haven’t been submitted for insurance approval yet, but if my insurance company requests 5 years, I may have an issue. I am considered low on the BMI scale (35), however, with my heart attack last year, high BP, high cholesterol, etc., my surgeon says I meet the requirements. I hope I’m not stressing myself out before I even get to the pre-approval process.

Thanks everyone!

It was several years ago but my insurance denied me because I went an entire year without seeing the doctor. Hance I did not have 5 years of Records.

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