Question:
About that STUPID 5 year obesity clause

Hey guys, sorry to keep bugging you all about this. This 5 year obesity deal that Blue Cross/Blue Shield requires, what does that entail? Can I submit paperwork showing that I visited the dr each year for 5 years and show I was/am a fatty? Or what do they need? This is the exact wording from their website: At least a five-year history of Morbid Obesity supported by medical record documentation.    — 1fatgurl (posted on October 19, 2006)

October 19, 2006
Hi, I do insurance billing for a living and what BC/BS is saying is that you must have a 5 year history of being MO. You probably haven't been with them for the last five years. So all you should have to do is submit Dr's records to show that you have been MO for the last 5 years. Your PCP should have this in his records so you should be able to ask them for copies of your weight off your record for the past five years. They may charge you a few bucks to do it, but most will. Good Luck.
   — Sheryl H.

October 19, 2006
I was approved throught Aetna and they required the same thing. I went to all of the doctors I had been to for the past 6 years (just to be on the safe side) and got copies of my charts and they all had my weight on them and also stated that I was MO. The insurance company got copies of all of that plus I put the data in an excel graph to show them I have been overweight forever and it was just getting worse.
   — *Malena* M.

October 19, 2006
Nancy, it is not just BCBS, my sister had the same problem with United Health Care (UHC), her policy from where she retired from. It is not the insurance company per say, it is how the policy is written. The reason I say this is because my same sister was recently employed by a company that also has UHC and she had her RNY in Sept. She did not have to be MO for 5 years. She did not get denied because of not being MO for 5 years. This UHC policy said that it had to be medically necessary for her to have surgery even though she was only MO for 2 years. Chris
   — ChristineB

October 19, 2006
I have BC/BS and besides being medically necessary, the 5 year history of being obese was a requirement. That was not a problem but rather than send them copies of my medical records I ask my doctor to list my top weights for 5 years on letterhead and that was acceptable. Good Luck.
   — god4me2

October 20, 2006
I have BCBS and they accepted documentations of all my weigh-ins when visiting the doctors for general care. My doctor did not charge me for this benefit. My approval thru BCBS was quick. They sent me a check-off list via email of all its requirements for WLS. Benita Lewis
   — NEETAJEAN