MVP EPO insurance plan and getting approved

(deactivated member)
on 1/23/16 2:08 pm

Just wondering how many of you have had your surgery approved through MVP insurance.  They are based in New York. I live in Florida and have the EPO plan. Are they more likely to deny or approve WLS?

they told me I need to have proof that my weight has been an issue for 2 years, documented proof that I've tried a medically monitored diet plan for at least 6 months, and have a BMI of 40+ (35+ with weight related health issue). 

I've had weight issues my whole life. Not sure where to start with documenting this. 

hollykim
on 1/24/16 1:26 pm - Nashville, TN
Revision on 03/18/15
On January 23, 2016 at 10:08 PM Pacific Time, Brooke1234 wrote:

Just wondering how many of you have had your surgery approved through MVP insurance.  They are based in New York. I live in Florida and have the EPO plan. Are they more likely to deny or approve WLS?

they told me I need to have proof that my weight has been an issue for 2 years, documented proof that I've tried a medically monitored diet plan for at least 6 months, and have a BMI of 40+ (35+ with weight related health issue). 

I've had weight issues my whole life. Not sure where to start with documenting this. 

for documentation,you would need doctors visits,including a weight,on those visits for 2 years. You also need proof of 6 months of medically ,doctor supervised weight loss.

if you have seen a doctor recently,or in the past,you should know if you have diabetes,sleep apnea,high blood pressure etc that are co morbidities. What is your current BMI?

 


          

 

(deactivated member)
on 1/24/16 2:23 pm

Im 5 ft 6 and weigh 260. I think my bmi is around 40-42 right now. I have pcos, a testosterone dificiency, high cholesterol, and hypothyroidism. 

My concern is that I was able to drop over 100 pounds in 2012, I went from 317 pounds to 195 in a little over a year with a strict diet and exercise routine but then my hormone issues kicked in and I've ballooned up over the last 2 years. I still work out and eat healthy. I'm on so many meds it's ridiculous. The weight isn't budging. 

Will the the fact that I lost weight then gained it back hurt me?

 

hollykim
on 1/24/16 4:35 pm - Nashville, TN
Revision on 03/18/15
On January 24, 2016 at 10:23 PM Pacific Time, Brooke1234 wrote:

Im 5 ft 6 and weigh 260. I think my bmi is around 40-42 right now. I have pcos, a testosterone dificiency, high cholesterol, and hypothyroidism. 

My concern is that I was able to drop over 100 pounds in 2012, I went from 317 pounds to 195 in a little over a year with a strict diet and exercise routine but then my hormone issues kicked in and I've ballooned up over the last 2 years. I still work out and eat healthy. I'm on so many meds it's ridiculous. The weight isn't budging. 

Will the the fact that I lost weight then gained it back hurt me?

 

not necessarily. It depends on exactly what your insurance requirement  specifies. Some want proof of loss with no gain and some only want proof that you tried and weren't successful. Losing it and not keeping it off is sort of a gray area.  Have you read your policy for yourself to see what it says? 

PCOS may be the only comorbidities you have but your BMI should qualify you.

 


          

 

(deactivated member)
on 1/24/16 5:35 pm

I'm working on getting a copy of the actual policy right now. Every time I go to the website to look up my benefits, it says they aren't available. :(

hollykim
on 2/5/16 3:16 pm - Nashville, TN
Revision on 03/18/15

call them and ask tobe sent a copy. If they give you the run around,tell them you KNOW,that by law,they. hAVE to provide you with a copy if you ask for it.

 


          

 

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