Insurance question

MargieM · May 21, 2008

I have United Healthcare (UH) for insurance. One requirement is that you have to be at least a 40 BMI before being approved for surgery. Another requirment is five years of being overweight/obese. My lapband doctor's office states I need the last five years of weight history from my doctor's office to be submitted with the Insurance approval request. I don't have five consecutive years for weight - and even if I did, it's all over the place - up and down from dieting - so I am sure it wouldn't be a BMI of 40 all the time (right now I am just barely making a 40). I called UH and asked them to go over the requirements again. The representative I talked to said a doctor's letter should work for the approval. My doctor agreed to write a letter stating my issues and trials over the last five years regarding my weight.

My question is - did anyone else submit a letter from their doctor with the insurance approval request? And did you have any problem getting approved? I am worried they will try and deny the claim. I don't have the five year weight history. :confused2:

yvianelli · May 21, 2008

Hello,

I had and still have United Health insurance and I did not have 5 years of medical history of being overweight whatsoever. I went the doctors office that I was recommended to go and saw the doctor one time and he submitted all of the necessary paperwork. I would change doctors or get a second opinion they (United Health) should allow the surgery based on your Doctors letter. I hope this helps.

Yvonne

Feel free to email me again should you have any additional questions or concerns.

AliNSanDiego · May 21, 2008

I have UHC as well. When I called I got the same answers.

Over 40BMI OR 100 pounds overweight &

5 Years Weight History

When he said 5 years weight history I took that as 5 years of being fat (which I have been).

Did they specifically tell you it needed to be doctor documented weight loss efforts?

I have my appointment with the weight loss center this Fri. I hope at this appointment they can give me more info about this entire insurance process.

glorybee123 · May 21, 2008

I have a friend that was "missing a year" because she didn't see a doctor and they let her send in a dated photo of herself to show that she was fat.

MargieM · May 21, 2008

Thanks for all the replies. This makes me feel better. My doctor is sending me the letter. I asked her to write all the diets that I have tried and state that I have been heavy for five years - which I have...even longer if they need pictures! If this doesn't work, I don't know what else will. It's not right that Insurance companies have all these demands on patients. I know insurance companies need to be careful, but if your doctor recommends that this is a good thing, Insurance companies should comply and do what is best for their patients. Again, thanks for the replies...it helps. I just hope the weight loss surgeon doctor will submit with the letter.

Edited May 21, 2008 by MargieM

MargieM · May 21, 2008

UHC said a letter should be fine - even though they state five years of history from doctor. The UHC rep didn't say I needed five years of charted weight history. But, the Weight Loss center receptionist said I did need five years of doctor documented weight history. Insurance policies vary company to company - whatever your company negotiates for the plan - so really, I don't think the receptionist can make such a general statement - but she has probably done this many times, so she may be speaking from experience.

Edited May 21, 2008 by MargieM