Oxford freedom plan, ny

Sinduin
on 2/22/12 3:08 am
 Just starting this journey. Has anyone dealt with Oxford freedom plan? I have a bmi of 36 with pcos, prediabeties, mild sleep apnea. What has your insurance process with Oxford been like?
brjday
on 2/23/12 6:01 am
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:
    • 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.
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