Insurance + 5 year documents

Hi,

I just started this process. Sent a message to a couple of WL clinics in my area. The first one called my insurance and they was told that i needed 5 year history of my weight and if BMI under 40, at least one (or two, can't remember) co-morbilities. 

I have High cholesterol, but my doctor didn't put me on medications. I have had HC for about 9-10 years or so (since i've had my first blood test really).

I have had horrible back pain for about 1.5 years, where i can't sit or stand up for more than 10 minutes without pain. I have had MRI and X-rays which shows too much fat pressing against my spine which is narrowing the canal as well as arthritis in my hip joints. I dont believe this is a co-morbility, but wanted to check with someone who might have an answer.

The woman from the clinic asked if I had diabetes or HBP and i said no (havent gone to the doctor for a while). She told me she doesn't think HC would be considered a co-mobrbility. I have read a lot about it and they all state HC is a co-morbility. Do insurances pick and chose which co-morbilities they will approve the surgery for?

Also, for my 5 year history. Well, I have move A LOT in the last 10 years... California (2 different cities), Canada (4 different cities), Washington (1 city) and now Arizona. I have NO idea which doctor i've seen 5 years ago... After searching and searching, i remember seeing a doctor around the end of 2012 but that's it. I've seen a couple after 2012, but its a blank before that. I've been overweight all my life, it's just that i dont like to go to the doctors unless its really a necessity. SO, I guess i could give my medical record from the end of 2012, then in 2013 and 2015. Is there a way to get around that 5 year history and provide the 4 year that i do have? It's not like i wasn't overweight 5 years ago, it is just that i do not have a medical file from then.

Thanks a lot :)

You will really have to get this spelled out for you by the insurance company. Every policy is different.

As for co-morbidities, pain is usually not considered. Diabetes, sleep apnea, and high cholesterol are usually universal. Some take high cholesterol and arthritis, some don't.

Some will take attendance at Weigh****chers or Overeaters Anonymous as proof of long term weight and attempts at weight loss. Some won't. Get some ideas from folks here, but keep in mind the only answer that counts is what is written in your specific policy.

If your current BMI is under 40 the insurance may require the additional info to approve. 

But if insurance will not pay - you can always chose the self paid option.  It sucks...but that may be the only choice you have. 

They might accept your weights from 2012, 2013 and 2015.  If you were a member of Weigh****chers, they can give you records.  Other diet groups can do the same.  Talk to your insurance company for clarification.  A lot will just depend on *****views it and whether they think you are a candidate for surgery.

The conditions most commonly accepted are

• Arthritis
• Sleep Apnea
• High Blood Pressure
• High Cholesterol
• Type 2 Diabetes

I had the same requirements (United Healthcare),  and i was able to provide visits from my doctor that recorded my bmi. I also had Type 2 diabetes,  so easily met all of the requirements.  I hope you're able to find everything that you need.  

Hi Deanna,

I am with United Healthcare as well. When you say that you were able to provide your BMI from your doctor, did you mean all 5 years or just what your doctor had? thank you

I had been seeing that doctor for 6 years ava had been having medical issues,  so i had at least one visit each calendar year. If you went to the doctor,  even for a cold,  they should record your weight.  

If you hadn't gone to any doctor,  you will probably have issues.  Which dates can you provide?

I remember seeing a doctor around november 2012, sometime in 2013 and in 2015. I may have one in 2014, but i am not 100% sure. 

As for before 2012, i remember seeing one in 2009 (i would have a very difficult time trying to remember who it was) but i wasn't nearly as overweight as i am now. Probably around a BMI of 32 or so. 

If you can get 2014, you might be able to do it.  Provide 12, 13, 14, 15 and 2016.  That's 5 years.  Count this year and you're golden.