Same story, different day

boredryu · April 7, 2008

I went to the free seminar and setup an appointment. I already knew my insurance company covered it but I didn't know all of the requirements.

I called this morning to find out the only requirements are "medical necessity". I asked if there was anything else then they said no. She told me to be completely sure I should talk to their "care now coordination" (uhc) and so I did. The lady said she didn't know for my plan specifically but for all of uhc there is a 5 year medical history needed.

That of course got me discouraged. Since I havent been to the doctor in years with the exception of for the dermatologist and my weight has never been recorded.

What should I do? Your advice would be appreciated.

Edited April 7, 2008 by boredryu

Luu2008 · April 10, 2008

I'm also worried about my 5 year history...both my PCP and Bariatric program people don't seem worried. I am a huge yo-yo and am lower BMI-just barely morbidly obese currently. Anyway sometimes my weight was low, as in as low as 160, other times I was as high as I am now, however Dr records usually show somewhere in the middle, but not technically morbidly obese. I'm anxious to find for myself how that 5 year history will play in with my insurance company. My PCP said she would write a letter of support along with my comorbids and felt I qualify under my insurance. She has several WLS patients and I trust her judgment. will admit I've put a lot of time and effort into this and if I'm denied its going to stink.

From the sounds of your post you haven't been to a PCP or had weight done in the past 5 years? I'm thinking you may not have comorbids or be unaware if you do have any. I think that if you have a high BMI w/ comorbids they aren't gong to care so much about the 5 year but I could be wrong about that. All the test you will soon go through may show some things that can be used to enable insurance coverage of the surgery.

Good luck!

Chris61 · April 11, 2008

I had the same problem. However I was able to find some old records that was beyond five years and that work. Also you can put a thing in there about you could not obtain records from all other doctors because they no longer have your file. Also you can use your OBGYN records as yell. We had problems with my wife pcp in regards to past weights etc. His excuse was HIPPA. So we just went to the OBGYN and had them do the same letter and she was approved within 20 minutes after it was resubmitted by the doctors office. If you would like to see the letter send me your e-mail and I will forward it to you. We both were approved in less than 30 days. I hope that this will help you out.

Chris

Mom2_4 · April 12, 2008

I also have UHC and needed a 5 year history. I had records submitted from 2002-2003 from one doctor and also records from my current doc starting in 2007. Nothing was submitted in between. They approved me right away. From what I understood about it, they just want to know that you have had the diagnosis of morbid obesity for at least 5 years.