Oxford freedom plan, ny
Hey there. Best of luck to you. It may be difficult. I just went through the process with Oxford. Be prepared for a fight. They will do everything they can to deny you. They are pretty specific with what they consider a co-morbidity, and I am pretty sure they will deny you. Where is your policy written? Your appeal options will vary by state where the policy was issued as well as if you are fully-insured vs. self funded..
If your BMI is less than 40, you have to have one of the following:
If your BMI is less than 40, you have to have one of the following:
-
- Cardiovascular disease (e.g., stroke, myocardial infarction, stable or unstable angina pectoris, hypertension or coronary artery bypass)
- Life-threatening cardiopulmonary problems (e.g., severe sleep apnea, Pickwickian syndrome, obesity-related cardiomyopathy)
- Type 2 diabetes
- AND
- Patient selection criteria for bariatric surgery include (NHLBI, 1998):
- Active participation in an integrated clinical program that involves guidance on diet, physical activity and behavioral and social support prior to and after the surgery.
- Psychological evaluation to rule out major mental health disorders which would contraindicate surgery and determine patient compliance with post-operative follow-up care and dietary guidelines.
- Documentation of a motivated attempt of weight loss through a structured diet program, prior to bariatric surgery, whi*****ludes physician or other health care provider notes and/or diet or weight loss logs from a structured weight loss program for a minimum of 6 months.