Question:
Has anyone been denied due to 5 year rule

I have been serching for a surgeon. I found one at one of the best Hospitals in the States. I noticed that in the qualifications for surgery he said that one should have been at a 40 BMI or higher for the previous 5 years. I was wondering if anyone had a problem with this? Or anyone who has used Dr. Grant @ Duke in NC? Other than this new rule I belive I qualify. Thanks!    — Amanda B. (posted on April 30, 2002)

April 30, 2002
Try Dr. Valin in New Haven Connecticut. My BMI has only been greater than 40 for a little over a year, I have a surgery date of May 9th.
   — Linda A.

April 30, 2002
I know the main source for the 5 year rule is that a few states (I mainly know of Indiana and if I remember correctly, Georgia) that have laws that if a person has been MO (bmi over 40) for 5 years or more, that insurances have to cover WLS. I am not sure about North Carolina. But this law kind of serves as a double edged blade. It is great for those who have been MO for over 5 years, but not so great for those who haven't. Surgeons may set there own criteria, and if his is that you have to be MO for 5 years and you don't qualify under his rules, look for another to see if they have different criteria. Good luck
   — Dell H.

July 5, 2002
My insurance company is telling me they have this 5 year rule. They turned me down and I am now appealing but I'm not sure of my chances because while I have been at least 80lbs overweight for the last 5 years, I haven't been 100 lbs over until this year.
   — susanne S.

August 10, 2005
Hi, my insurance,Aetna PPO, also denied me based on the 5 year rule. I paid cash,instead, for this surgery. I swear, I think it should be illegal to require this as it is a prescription for heart disease and diabetes. I really think that insurance companys are desparate to control this financial drainer (to them) because so many of their insured clients qualify. It is so unethical.
   — Gerry

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