Jump to content
×
Are you looking for the BariatricPal Store? Go now!

Recommended Posts

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?:rolleyes:

hmmmm

thanks

Share this post


Link to post
Share on other sites

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 by hope2bthinr
quote from Tricare Pol Manual added

Share this post


Link to post
Share on other sites

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?

Share this post


Link to post
Share on other sites

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

Share this post


Link to post
Share on other sites

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:{

Share this post


Link to post
Share on other sites

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 by hope2bthinr
spelling correction

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • BeanitoDiego

      I've hit a stall 9 months out. I'm not worried, though. My fitness levels continue to improve and I have nearly accomplished my pre-surgery goal of learning to scuba dive! One dive left to complete to get my PADI card 🐠
      I was able to go for a 10K/6mile hike in the mountains two days ago just for the fun of it. In the before days, I might have attempted this, but it would have taken me 7 or 8 hours to complete and I would have been exhausted and in pain for the next two days. Taking my time with breaks for snacks and water, I was finished with my wee jaunt in only 4 hours 😎 and really got to enjoy photographing some insects, fungi, and turtles.
      Just for fun last week, I ran two 5Ks in two days, something I would have never done in the past! Next goal is a 10K before the end of this month.
      · 0 replies
      1. This update has no replies.
    • Teriesa

      Hi everyone, I wrote back in May about having no strength. I still get totally exhausted just walking from room to room, it’s so bad I’m using a walker with wheels of all things. I had the gastric sleeve Jan. 24th. I’m doing exactly what the programs says, except protein shakes. I have different meats and protein bars daily, including vitamins daily. I do drink my fluids as well.  I go in for IV hydration 4 days a week and feel ok just til evening.  So far as of Jan 1st I’ve dropped 76 lbs. I just want to enjoy the weight lose. Any suggestions or has anyone else gone thru this??  Doctor says just increase calorie intake, still the same. 
      · 0 replies
      1. This update has no replies.
    • Stone Art By SKL

      Decorative Wall Cladding & Panels | Stone Art By SKL
      Elevate your space with Stone Art By SKL's decorative wall claddings & panels. Explore premium designs for timeless elegance.
      · 0 replies
      1. This update has no replies.
    • Clueless_girl

      Losing my hair in clumps and still dealing with "stomach" issues from gallbladder removal surgery. On the positive side I'm doing better about meeting protein and water goals and taking my vitamins, so yay? 🤷‍♀️
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      I've hit a stall 9 months out. I'm not worried, though. My fitness levels continue to improve and I have nearly accomplished my pre-surgery goal of learning to scuba dive! One dive left to complete to get my PADI card 🐠
      I was able to go for a 10K/6mile hike in the mountains two days ago just for the fun of it. In the before days, I might have attempted this, but it would have taken me 7 or 8 hours to complete and I would have been exhausted and in pain for the next two days. Taking my time with breaks for snacks and water, I was finished with my wee jaunt in only 4 hours 😎 and really got to enjoy photographing some insects, fungi, and turtles.
      · 1 reply
      1. BabySpoons

        Amazing! Congrats!!! Watch out for the sharks. 🦈

  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×