I just had another thought - the clinical bulletin is, at least in UHC's case, very different than your plan document. UHC had issued a clinical bulletin - available on the web - that said in general, WLS was reserved for those with BMI of 40 and no comorbids, or BMI of 35 with comorbids. It also said that the individual contract under which an insured is covered trumped their clinical bulletin.

My individual contract required a BMI of 40 with no mention of comorbidities, period. Plus, it required a 5 year history of morbid obesity. And, that is what "won" when it came to deciding my preauthorization approval.

Hopefully this illustrates the importance of getting your contract vs a clinical bulletin. MAKE SURE this comes from your employer/the organization that you pay for your healthcare.

Laurie

Hey,
I'm not entirely clear - are you required to show history of morbid obesity, or history of failed weight loss attempts? It seems like it might be the second, and if this is the case, you may be ok, depending on the timeframe they want to see. If it is a history of morbid obesity (this was a requirement I had in my UHC claim), I pulled pages from various points in time. Don't forget to get records from places like urgent cares and your GYN if they help support your case.

Just make sure your medical chart clearly shows the ups and downs in the correct timeframe. And, based on what I have read from others, a BMI of 43 should be enough to qualify.

But, as I put in my original post, be sure to get a copy of your contract so you know specifically what you have to show.

Good luck!
Laurie

Hi!

Just curious if any of you have Blue Cross Blue Shield of Mass, and if so, about how long did it take to get approval from them? My surgeon would like to do my surgery in September but I'm still waiting approval.....

Thanks!

I have United Healthcare Choice Plus PPO.

Idk why they require that :/ I've called several times and the reps always tell me it isn't required, however the office coordinator for my WLS surgeons office says it is. So I'm kinda stuck.

I feel ya...I have to somehow get 5 years together. It's going to be hard! In 2011 for example, my BMI dipped way below 40 from a severe unhealthy crash diet. But unfortunately it was during that time that I have any documented Dr. office visits :/

Other than that ONE year, I have always been in the super morbidly obese category.