Has anyone been able to appeal not haing a 5 year history...

I have just beed denied by UHC because I do not have a 5 year history of a BMI of 40 or above. I was just wondering if anybody has ever been denied for this and appealed and then was approved?

Hello, If your benefit language states needed specific documentation of 5 years with a BMI >40, then this is what you will need to provide. Any past Md notes that have your weight on it within that time frame should be gathered. If you have not been morbidly obese for this amount of time, you may have to wait until you can provide the required documentation.  Appealing this without meeting the requirement is really pointless. Insurance companies administer the benefit language that your employer specifies, they don't make the rule. They just make sure that you/your Md provides all the stated requirements based upon your SPD (Summary Plan Description). If you meet all of them, you are approved; thus if you don't, you are denied. Wish I had better info..... but I know how this works!    

I was without insurance for nearly 4 years before I just got covered again and I have been running all over town trying to get records to document my weight during that time (I don't think the insurance company will deny me because I can't document that my height has stayed the same).  I have found the documents I need.  Even thought I wasn't insured I did have a pap smear for some of the years, I had a cold and went to an urgent care center one winter, I had a concern over a mole one year and went to a dermatologist once ... Each of those times I was weighed and they wrote it down.  I also tried working with a personal trainer and although he didn't keep my records, I kept the little card that showed my progress so he signed a letter stating that he worked with me (for the couple of months before I stopped going) and he certified to the weight.  All together my surgeon thinks I have a good history.  If your BMI wasn't below 40 the whole time, can you point to any co-morbidities?  Many policies provide that you must have a BMI of 40 or it can be 35 if you have co-morbidities such as sleep apnea. Hope this helps.

Perhaps you could add a few pictures from that time period (if you have any I know we don't take many pictures do we).  I don't know if it would help buy it might strengthen your other documentation. Blessings, I will keep you in my prayers

I am waiting to hear from UHC, but I'm afraid I'll be denied for that reason.  I have had a BMI over 40 for a little over a year, but it's been over 35 with co-morbidities for at least 5 years. I'm very frustrated about the 5 year clause.  With me already overweight, my co-morbidities, and my family  history, I probably won't make it four more years.  Besides that, if I did, who's to say my company would still have the same insurance co, and/or the same restrictions would still apply?

Have you tried sending proof of the five years 35 BMI with comorbidities?

I am still waiting to hear from them, but that's my plan if/when they deny me on the initial try.

Have you been denied already? If so what were your next steps? I just found out today I was and I'm not sure what else to do?