Does anyone know, when an insurance company requires you to be 100 lbs over ideal weigt according to MetLife chart, do they mean the lower or higher weight in that given range for medium build?

For example: MetLife ideal weight = 119-132, do you qualify as 100 lbs over ideal weight if you are 219? or 232?

hmmmm

thanks

hi kat

i'm not sure , but wouldn't it be anywhere inbetween? just a thought:)

If you're talking about TriCare, it requires you meet the 100lbs over both the high and the low. Which just seems crazy because obviously if you're 100lbs over the high of that range, you are more than 100lbs for the low end. So why don't they just specify "you need to be 100lbs over the high end of the range for Metlife Height and Weight for the applicable body frame." Anyway, I read the particulars for Tricare which is the only ins. besides maybe Medicare/ medicaid that doesn't go by Body Mass Index. This is copied from the manual...

B. In determining the ideal body weight for morbid obesity using the Metropolitan Life Table, contractors must apply 100 pounds (or 200%) to both the lower and higher end of the weight range. Payment will be allowed when beneficiaries meet all requirements for morbid obesity surgery including the ideal weight within the newly determined range.

Edited June 11, 200917 yr by hope2bthinr
quote from Tricare Pol Manual added

that is my initial assumption, but when it comes to insurance companies.....

thanks

well... if that is the case i am 4 pounds short. if it were the lower end of that range I would be 107 poinds over ideal weight. should i expect to be disqualified for this i wonder?

Kat- I have heard of people getting denied for only 1 lb under the 100 lb mark. I had to gain 6 lbs to qualify. My scale sucked at home and I ended up gaining 13 lbs instead. ARGG:cursing: So I sure do hope I qualify or I would have gained for nothing. Anyway, I hope you get approved but I know Tricare is knit picky about certain things. Jennifer

i couldn't stand it any longer so i called tricare. the above note is correct about contractors addingthe 100 pounds to the lower and higher...it is so to qualify for morbidly obese one would have to fall within the new range: for example: 5' 3" med build ideal= 121-135 for 100 pounds over, one would need to be the new range of 221-235. for 200% it would be 242-270. whew... i never thought i'd be happy to be considered morbidly obese:{

hope2bthinr

Thank you!! That excerpt helped:)

Thank YOU!! I guess I really didn't understand what they meant by that, the way it's written either. But then, policy manuals...what's perfectly clear to the writer may be perfect mud to the reader!! Thanks so much for posting what you found out.

I had downloaded all the pertinent parts of the manual to provide to my doctor's patient coordinator (they hadn't done a preauth for lapband thru TriCare before) because I wanted to make sure they knew what the records need to say perfectly so I don't get a denial. I don't want to delay anything by having to go through the appeals process. Good luck to you!! and to all of us joining the journey.

Edited June 12, 200917 yr by hope2bthinr
spelling correction