Proof of BMI at or above 40 for 5 years?

I have found that this is, indeed, common. I actually would go further and get everything in writing from your insurance company. That way, it isn't a "but you told me this!" a few months from now.

I have found that if they require a 2 or 5 year period of an obese BMI, it's far more lax than the 3, 6, or 9 month "supervised diet" requirement. Statements from PCPs about your weight often suffice. Again, you will need to verify exactly what is required from your insurance, however.

I know it sucks -- and what Grim said is so true.

If you can find a surgeon that you trust who is part of a bariatric center (meaning it includes dietitians, psych, aftercare, and specialized billing/insurance approval) -- it is far easier to navigate. I ended up using a "Center of Excellence" for this exact reason. Extra bonus: they are usually far more likely to be covered under insurance policies.

http://www.obesitycoverage.com/insurance-and-costs/pre-appro val-process/center-of-excellence

Thank you so much :)

Can I ask why you think you don't have apnea? On another thread, you said you snore so loudly, you wake your husband. That is a classic symptom of sleep apnea.

If is determined you don't have apnea, I can't see how it would hurt your chances, as long as you meet the basic requirements your insurance has set. If you do have it, it may make the approval easier.

But as others have said, no one but your insurance company can answer your questions as to requirements. Even people who have the same insurance company can have different requirements, as what one employer is willing to pay for can differ from another.

I'm one of the (apparently rare) people with insurance that required proof of BMI over 5 years. I had to submit a doctor's note for each of the five calendar years prior to surgery with a weigh-in, so some came from my GP, one came from urgent care, and I think one even came from my annual gyno check-in. From what I've seen of others posting here, any sort of medically-documented weigh-in is good enough.

My insurance required BMI over 40, or over 35 with comorbidity. In the 5 years before surgery, my BMI ranged from 37 to 48, but I was diagnosed with sleep apnea about a year before speaking to my surgeon. Apparently that was good enough, even though the BMI between 35 - 40 was before the apnea diagnosis.

My experience only, yours may be totally different-- most insurance providers vary quite a bit.

I agree with others that you may have apnea without knowing it; I certainly did. My husband complained about my snoring, and it turns out I had mild apnea. The good news on that front was that I slept SO much better once I got a CPAP, and I was able to ditch the machine about 6 months post-op.

Thank you so much!

The point of a weight history is to verify that you aren't seeking surgery after a large sudden weigh gain.

Insurance companies prefer that you have a history of weight loss and regain as opposed to a slow steady gain with no effort to lose.

I can only speak of my own experience. Every company and plan within is different. My insurance company DID require a five year weight history, as well as 3 months of visits with my PCP for 'medical weight loss management', and four visits (total) with a dietician (one eval, 3 follow-ups). I also had to get clearance from pulmonology and cardiology.

My spouse is the insurance holder, so he called the insurance company (and verified with HR) that the surgery was covered. He also asked for the specifics in writing. The insurance company gave him a link to their web site that specifically delineated the requirements. I then shared the link the with Bariatric Center as the policy had been updated only a few days before.

I also made up a quick spreadsheet listing the requirement, and filled in the the dates as I completed each. This was apparently helpful to the insurance processor at the center, as she didn't have to look up each data point.

When I went to the PCP, he had to document each visit as "medical weight loss management', so it was coded and billed correctly. To get the five year weight history, I sat there with him as he literally paged through my patient file (most of it was pre-electronic records). I have sleep apnea, so the pulmonologist reviewed the records from my CPAP and shared that info with the surgeon and anesthetist.

The surgeon is part of a Bariatric Center of Excellence, so the dietary, etc. was through his office. Once I made the decision to have the surgery, I didn't want any missing paperwork, etc. to hold up the process. All the t's crossed and i's dotted, etc.

(Why does spell check think that "bariatric" and "pulmonologist' are spelled wrong?)

Oh my gosh thank you for all of the great helpful info. Thanks again!