Must meet certain guidelines...Insurance Question...???Avmed...

Hello everyone.. I find this message board a great help...thank you all... I am 5'1" and weigh 210...My BMI is 40. I am 52 yrs young..(he he)..I have just started the process of seeing Dr Rosenthal in Weston Florida (Gasto Dr)..and started the process of making all appointments for the tests....Upper GI...etc. I am a bit confused as to what my insurance company will be looking for...regarding the criteria to meet requirements. Although my BMI is 40 now..I dont think that it has been 40 for the last 5 years..I ranged from 190, 195, 200 or so/ Also,what are they looking for when they say, "documentation from MD of prior weight loss programs including programs and diet supplements." My MD (family dr.) put me on Xenical for around 1 year, about 1 yr ago...but, he did not monitor me...I might have lost about 20 lbs, but put it all back and then some...does that sound like that qualifies....some other comorbitities (sp) high cholestral, anxiety and depression..I take lexapro and had been on prozac for years...athritus (some)...I do plan on discuss all of this with my Family MD..who is not the same Dr. that prescribed the Xenical...cause I have a different insurance carrier since then... I am having alot of anxiety as to whether I will qualify or not...any assistance will help... My insurance is AvMed...SELECT Self Refer to Specialist SELF FUNDED I work for a city here in Florida.... Eileen

I cannot help you with Ins specifics but the person in the doctors office should know what is required. Call the doctor;s office that you want to do the surgery and ask for the Insurance specialist.

It sounds to me like you qualify, you just need to find out what your insurnce requires as proof of medical necessity. You can look up AvMed in the Insurers forum here and see what other people have said about them. Good luck! ~ T.

Eileen, If your dr put you on a medication--did you not see that Dr even once during that year for any blood work or anything??? If you did then that is Dr supervised.( I work for an Ins company). You have to call your specific ins compnay but from what you are syaing, you would qualify with mine, so take a deep breath, go to your pcp and get a letter and make sure he lists ALL of that information in it, also, get the records from the Dr that put you on that medication as well. Your best bet is to get copies for yourself too so you can take them to the Dr office with you since faxes tend to get lost!! Good Luck! Stephanie Lap RNY 8-6-03 253/162 today!! 12 lbs to my goal!

Thank you all so very much...I have an appointment with my new Dr. next week....and my records were sent to his office...I will be meeting him for the first time...so we will have to discuss what is in my chart...I am hoping that what is in there about the Xenical will be enough for my insurance to accept...I dont remember what happened after he prescribed the Xenical..that is I dont remember when or if I had a follow up visit with him...he wasnt strick as far as that goes...I keep hearing about having to have documentation of a supervised diet for a 6 month period...that is a long time to have to wait for an approval...if they feel that I havent met the requirements...I think that with this anxiety..I am beginning to overeat more than ever...I have to try and be patient I think..I know everyone on this message board went through the same thing.... THANKS EVERYONE......

Hi Eileen, I am so glad to hear that someone here is seeing Dr. Rosenthal. I am a patient of Dr.Rosenthal, I just completed all of requirements and I am now waiting to hear from Norma and Karen as to my surgery date. You should email Anita Houle she is in charge of the insurance department at CCF she has personally walked me through every inch of my insurance requirments. Here is her email address [email protected] she will respond faster to emails than she will to a phone call. Good Luck!!! Danielle

you had to of had prescriptions to have xenical right? Go to your Dr' office and request a copy of your medical records. I to am just starting this process and have asked the same questions as you..lol my BMI is 38 but trying to make it 40.8 to make sure I qualify.I am 5'2 215 lbs.I am not ovulating anymore.My cholestrol is high and triglcerides are extremley high..which makes me at high risk for coranary heart disease..Diabetes also run in my family and my glucose test documented my blood sugars were 117 instead of the 110 and under it should be.So I am at risk or I already have diabetes. all this are Co Mobidites and go through your dr's files and document anything you have proof of that could be a symtom of obesity..HTH before your initial consultation the more info the better your chances. Lisa PCB