Insurance question

It is so strange how the companies differ as well as doctor's too. But, I know that when they submitted my stuff, they went back to the early 90's even for me. There were times in the last 5 years where I had skipped my yearly ob/gyn appts and that was the only doctor I ever saw mainly. Anyhow, I have State heath/BCBS so I am not absolutely positive it has to be consecutive. My suggestion is to get any documentation and I even heard of a case where one girl had a picture submitted as well so perhaps that is even worth a shot. She said she didn't have all 5 years but had a time stamped pic so who knows with insurnace. I would just do like everyone has said. Good luck. I do know several people that have appealed as well and gort approved. Be persistent.

Please read your policy carefully.  My BCBS IL PPO policy said a history of morbid obesity of "at least" 5 years.  I didn't have doc records for the previous consecutive five years, but did have it for previous years (had 1993-1998 and then 2003 to the present).  This was acceptable to my ins co.  Also think back to see if you can get records from college, school physicals, etc.

My BCBS PPO for local government says that it has to be 5 consecutive years not counting the current year. As I said Dr Bauman's office said they could get it approved with 4 out of the 5 from 01-06. It has been said before though, every pt, dr, and insurance is different. Good Luck!!!

If anyone can do it, Kim can!  She rocks!  You're in good hands there.  Good luck and keep us updated!

Yeah, she told me that she could get me approved with 3 years and the letter from my medical director. Go to pcp in 2 weeks, and the shrink on 8/1. Hopefully this will all translate into a date in Sept or early Oct. I will be sure to keep everyone up to speed too. Thanks for the support.

Brian

From my experience w/ BCBS State is they need the last 4-5 years. They need at least 4 years from 02 - 06 so if one year is missing they want worry to much as long as they have 4 weights to look at. SO if your weight dropped in the 35-39.9 range one of those years then just don't provide that year. I know that is wrong but it will get you approved. Depending on the doc that reviews they could either deny you for it or approve it if you provide all the weights. I would be safe and only supply what you need to. BCBS is very easy normally get approval. Supply them w/ the documents and you are good to go.  Good Luck!

I just received my denial letter from BCBS.  My documentation showed that I didn't not have a bmi of 40 or more for 4 of the five years nor do I have any co-morbidities.   I'm going to try to appeal or finance the surgery myself.  Make sure you have that 5 years or else they will deny you. 

Thanks to all for the responses.  My computer has been at the Geek Squad for the last few days so I havent checked my messages.  Unfortunately I only have four years of documentation 03-07 (nothing for 06) so I may just have to keep waiting.  During those four years, I like many of you tried unsuccessfully to shed those lbs. So my weight fluctuated from  a  bmi of 40 to a bmi just under 40.  Many of you gave some great ideas about documenting my weight.  I just don't have it.  I avoided getting on the scales.   I also do not have a long history with my doctor.  When I talked to her about weight loss surgery and having her to write a letter and fill out the required forms, she was willing but would fill out anything she couldn't document. I even showed her pictures of me with my kids when they were small and me with my kids now.     However, I went to go back to my PCP the other day because of severe reflux and told her that I have had several episodes before, she gave me samples of protonix  for reflux.  She never mentioned the word GERD but I'm hoping that will help my case since GERD is considered a co-morbidity. I hope to go to DR. Mitchell in Pinehurst. Their bariatric center is a center of excellence.  His nurse, Carmen, told me to send all my records to them and if their is a way , they will find it.  She told me their is still hope.  she also told me that 2007 would count as one of the years.  I hope she's right. My state health plan states" Morbid obesity (bmi 35 or greater associated with at least one of the problem listed in A. 1.b. or bmi of 40 or greater) has been present for four of the previous five years.  It's frustrating but I have to keep on going.  Thanks to everyone and I'll let you know how it goes. Tammy

Oops sorry I just repeated a lot of the info that  I posted the other day, I didnt see it and didnt think it went through since my computer has been crashing.