Oxford United Health Care: 6 month documented diet?

mharroun
on 10/11/12 8:10 am - Forest Hills, NY
DS on 11/06/12
 Im in the process of doing all the requirements needed to have the duodenal switch surgery and I cant get a stright answer on the requiremetns for insurance to cover my procedure.

Here is the current PDF:
https://www.oxhp.com/secure/policy/bariatric_surgery.pdf

I have a BMI of 58 and Sleep Apnea, GERD, and a hatal hernia... when i call oxford twice asking about it and I am told that I do not need to do the 6 month documented medicly reviews diet(seems like just phone support reading off the same paper i linked) .... but from what I read around and what the surgons office has told me that its allmost allways required...


The document reads:
1 . Class III obesity (BMI > 40 kg/m2); OR
2. Class II obesity (BMI 35-39.9 kg/m2) in the presence of one or more of the following comorbidities...; AND
3. (part about 6 month diet)

Since my BMI is over 40 does that mean I am excluded from the 3rd part? Thats what the  epresenatives have told me... and by boolian logic (TRUE or FALSE and FALSE) = TRUE.... 

I am hoping someone who has had oxford and a high BMI could tell if they had to get the 6 month documentation...




 
mharroun
on 10/31/12 9:42 am - Forest Hills, NY
DS on 11/06/12

Guess i should report back... Was approved in 3 days without the 6 month weight loss...

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