united health care 5 years?

i have united heath care choice plus and went to see my surgeon yesterday and book my surgery march 19th. NICE.  but before i got home i checked my messages and there was a message from the inurance dept.  my insurance company wants 5 years of weight history.  Problem is in the last 5 years my bmi has been as low as 35 and high as 42.7. right now im 42.   im freaking out that insurance wont cover it now. this is a new requirement as of 2007.  i have some minor comorbidies but i still dont know if they will cover it and i am really upset over this.  does any one know what it is that they are looking for in the 5 year history?  help please  what exactly are they looking at in the 5 year period so i know what to give them adam

Hi Adam. This is a great question and I am hoping that there is someone else who will chime in to help answer it with a more complete answer. If not, I would post it on the main message board.

My surgeons office thought my insurance required a 5 month history too and she said that basically I just needed to have my PCP send over records for the last 5 years (at least one visit a year) that documented my weight. Turns out I didn't need it after all but maybe that info will help you.

Jenifer

Adam-  I too have UHC Choice Plus and I just got off the phone with them to confirm some things that I needed to know.  You have to have " a diagnosis of morbid obesity for a minimum of 5 years from a physician."  You also have to have a BMI of 40 and be over the age of 21. I am told by my PCP that you just need to provide documented proof of your weight every year for the last 5 years. the insurance company can do the math and see what your BMI is for the years given. I actually have copies of the doctors notes with my weight recorded that I am faxing to UHC along with my other letters and documentation.   I will say a prayer for you. Shellye

im really woried that this can hurt me because in the last 5 years i was on jenny craig on and off for 2 1/2 years and my bmi was as low as 35 in that time frame and over 42. im having a hard time getting the records i need from 5 years ago hopefully i get them soon.

Hi, the Up and Down bmi just means that you have been dieting and struggling with your weight. I have read that record books from WW have been accepted as diet history, even when the doctor did not have it. If you have any records from JC, have them available as a back up. Your written recollection with dates and Dr's names will also be very helpful. Good luck,

I have UHC Choice plus as well and I was worried about the 5 year history so I just called them and they said I didn't need to show a 5 year history. Do you think this is determined by the employer or do you think i was given wrong information?

I would call them back and ask again...as far as I know- from what all of the UHC patients on this board are saying...... it is a new requirement since the first of the year.  Now I am no expert and I will be the first to admit when I am wrong....and I hope for your sake that you don't need the 5 year history. Please call them again and let us know what you learn! 

So I called two more times to see if different people at UHC would give me different answers and they all said the same thing, that my plan doesn't require a 5 year history and they also said I dont have to be 21 (I was worried about that too because I am 20 right now). They said that the 5 year history is something the employer requires, not them...I am hoping this is true...

Whoa Beth!  That is AWESOME!!!!  I am so glad for you! I stand corrected and I am thrilled that you don't have to  jump through as many hoops as the rest of us! Good for you for wanting to take care of the weight early on in your life!  I am 38 and I would have loved to have this surgery back then- I'd be thin now! Hopefully I will be soon enough!

I have UHC and was told yesterday that the 5 year weights is required.  I think it all depends on the plan.  i have the health choic plus.  I was escalated to a supervisor so I should hopefully have a determination today.  Their rules state a determination within 24 hours of escalation.  Keep you fingers crossed for me!!! Melissa