BMI

Hi everyone! I have a question for you all: the patient rep at my surgeon's office tells me that BMI of 40 is no longer enough for ins approval-some companies are now making people diet for 6 months in addition. I thought the whole point of the 40 BMI guideline was that at this point you didn't need co-morbids to qualify b/c it was assumed you were on the road to trouble. Has anyone been denied due to this and what did you do--is it possible an attorney would take a case like this?

Hi Julie, There are a lot of components for insurances. What insurance do you have? BC/BS HO, Aetna and Cigna require the 6 months of dieting. If you have already been to a doctor and have documented weigh ins for 6 months in the last 2 years...your in like flinn!! UHC usually just wants medical records with weights and a brief diet history. I was amazed the other day when I ran a patient throught with BC/BS PPO...all they wanted was a date of service and a letter of medical necessity!!! It just really depends on your insurance and what they want. One word for you! APPEAL!!! The only way I would contact a lawyer is if they come back and say that it is not covered at all. Hope this helps and you can contact me at [email protected] Susan Williams Patient Advocate Laparoscopic Weight Loss Surgery Centers Jacksonville, Fl