Question:
Anybody told they have to be 100+ overweight for 5 years or more to qualify?

I called my insurance company and asked what the requirements for bariatric surgery are. I was put on hold while the insurance rep called the review board. She came back and said that I had to be 100+ pounds overweight currently, which I am, I had to have tried other methods to lose weight, which I have, I have to be unable to lose weight without surgery, which is true, and I have to have been 100+ lbs. overweight for at least 5 years or more, this part is not true. I've been 80-90 lbs overweight for 10 years, but it has only been in the last 2 years that I've gone over 100. Has anyone else been told this? My insurance company is Blue Cross / Blue Shield of Minnesota. I asked if I had to have a referral from my PCP, she said no, I asked if I had to have a psychological eval, she said no, I asked if I had to have a dietician consult, she said no. How can I get around this? I have comorbidities to go along with my weight.    — Joni W. (posted on July 16, 2001)

July 16, 2001
The criteria you describe is pretty standard for Blue Cross. It seems that they may not be absolute sticklers for the 5 years, especially if you have other conditions that are getting worse because of the obesity. When you write you obesity history over the past be sure you include every time your weight went to 100# overweight. It does not have to be the LAST 5 years. And look at your height - are you sure you are as tall as you think (most of us lose height because of increased curvature of the spine with obesity.) When I would go to the doctor, I wanted to be as tallas possible so I would be less overweight - got that? Well, the fact that you may be shorter than you thought may mean you were 100# overweight when you thought you were only 80-90# overweight. I would not let the 5-year provision stop me from trying. All the insurance company can say is no. If they do, you start the waiting game or start highlighting the fact that delaying the surgery puts you at further risk. Good luck.
   — Anndrea H.

July 16, 2001
Although I was 100 pounds overweight for more than 5 years, BC/BS never told me to prove it. My bariatric surgeon just wrote a note saying I had been, and they took his word on that. When your surgeon asks you how long you have been overweight like this...just say "at least" five years. That's that. No proof was needed. Just the docs evaluation. Good luck
   — Barbara H.