Question:
No medical problems or documentation of weight history
I am 32, 6'2", approx 400 lbs, BMI 52. I have made the decision about having the surgery but I have one major problem...... I have been morbidly obese for about 10 years now and have had no medical problems. My back and legs/feet have been hurting so much lately. I haven't been to a doctor for about 15 years. I have an appointment with my mom's doctor on 6/24/03. I know she has refered many people for the WLS. I e-mailed my insurance company and they said it would have to be "medically necessary". I have tried every diet and exercise plan on the planet and have failed. I also tried a few weight loss centers about 10 years ago with no success. I am just wondering if anyone has been approved for the surgery without having years of documentation from a doctor???? I have made a long list of every diet plan, exercise plan and diet attempt I have made to lose weight and I also have many pictures of me dating back to 1994 all of which show me at least 100 lbs overweight. I just hope that this is enough for the doctor, surgeon or insurance company. — Roger C. (posted on June 22, 2003)
June 22, 2003
Who is your insurance company? Is that the only requirement that they
have - that it needs to be medically necessary. If so, you may be in good
shape. A lot of insurance companies are looking for 6 months of
physician-supervised diet and exercise program. Your BMI should be enough
to qualify you for the surgery w/o any comorbidities. Compile all of that
information and take it to the doctor and give it to them. If they
recommend you to a surgeon for WLS, they can provide that information to
the surgeon who will in turn provide it to the insurance company.
<p>
It's good that you are making the decision to have this surgery now.
Seven or eight years ago, I didn't have any medical problems stemming from
my morbid obesity either. Then they've hit me hard since then. I'm 11
months out and have lost 181 pounds since my surgery last July 17 (plus
another 13 between my initial consult and my surgery). Good luck on your
journey! JR
— John Rushton
June 22, 2003
Hi Roger...It's "medically necessary" because of your BMI alone.
If they don't ask for doctor supervised diet records for x-amount of time,
then there's no reason to worry. Sometimes just a list of all the diets
you've been on is documentation enough (if they even ask for it). I hope
you have no problem getting the referral from the doctor you're going to
see...it doesn't sound like you will. Hugs, Joy
— [Deactivated Member]
June 22, 2003
YES!!!. ...I was approved on 6/13/03, after only 5 days by Blue Cross/Blue
Shield PPO..I had No documentation of any previous diets and No illnesses
(co-morbids) of any kind...my surgery date is August 12, 2003... the best
way to do this is to FIRST find the Doctor and the progrom you want THEN
ask there insurance coordinator what plans are giving them the least
problems with approvals THEN get that insurance or switch to that insurace
if you have the choice.... Dr. Chin at Lite Dimensions in Fountain Valley,
CA is doing my surgery...they have a website you can go to
www.litedimensions.com...... Good Luck
— E. V.
June 22, 2003
Hi Roger, You do meet the criteria of medical necessity for this surgery.
That with documentation by a doctor of your muskuleskeletal issues will go
a long way. My insurance accepted a detailed list I wrote of the
diets/drugs I had tried. I had actually only tried to lose weight 5 times
in my life and one of those times managed to lose 200 lbs, but it did
eventually find it's way back. Other than that the most I lost was 35 lbs
on Redux and what I gained was a slight heart murmur.
<p>It will come down to your particular insurance company and what
their requirements are. If they did not say you needed a recent physician
supervised diet attempt of X time in the past year or something, then you
probably should be fine. The more you have assembled and organized the
less they are going to hassle you probably. The pictures are a good idea
too. It is not uncommon for morbidly obese people to avoid doctors, so you
are not alone. I avoided doctors for about 20 years and then when I
finally started going everything fell apart - body and soul! So for me I
had tons of documented co-morbs but with a 65.3 BMI I more than qualified
anyway.
<p>Have you been tested for sleep apnea? If not, it might be
something the doctor you see may want done. I thought I was fine and found
out I had quite severe sleep apnea 4-1/2 weeks before sugery. That just
solidified my approval. That is one condition that usually guarantees you
an approval, assuming they cover the surgery in the first place. Good Luck
and I wish you well on your journey. I am almost 5 months PO and down at
least 112 lbs. It's an awesome new life!!
— zoedogcbr
June 22, 2003
If you haven't been to a doc for ten years when he checks you out you may
have high blood pressure, high cholesterol or borderline diabetic. It will
make a difference because these diseases rate higher on the list than the
problems with legs and backs. Some insurance companies don't consider that
a co-morb. I have severe back and leg pain and had gotten to the point of
hardly being able to walk and already knew i had severe arthritis. My ins.
company said these things will hurt you so bad you will wish you were dead,
but they will not kill you. Therefore they are not a legal co-morb. Good
luck all ins. companies are different so it doesn't hurt to try.
— Delores S.
June 22, 2003
I had NO co-morbids or diet history(I just made one up) and I was approved
by Blue Cross PPO in 3 days just based on my BMI!!! Good luck to you.
— lovemonterey
June 22, 2003
Roger, you shouldn't have any problem with the documentation you have. All
you need to worry about is that your doctor/surgeon verifies that the
surgery is medically necessary, and from what you've written, there doesn't
seem to be a problem there. Good luck to you, and don't worry!
— Ceil G.
June 23, 2003
Roger....When my doctor submitted the request to my insurance company I had
no past medical records to send in with the request. The only info my
doctor sent to the insurance was info I had given to her. My insurance
company approved me after the first letter was sent in. In fact I got
approval twice. Once back in 2/2002 and once less then a month ago. This
last time it took them less then 24 hours to approve me. I guess it all
depends on your insurance company and what they want. Keep your chin up!
Be patient and everything will work out. Maria~San Antonio, TX
— Maria S
June 23, 2003
Hi, I did the exact same thing. I had no medical records or documeted diet
history whatsoever. I wrote letters, my family wrote letters, I sent
pictures, etc. all on my own to my insurance company. Read my profile for
more. Good luck! 212/118/108
— TP
June 23, 2003
I was in the same boat.. all I had to do was list the diets I had tried..
pills, shakes ,etc. I have no health probs.. but my family is riddled with
diabetes, heart disease and obesity. I had no trouble getting aproved...
only 13 days for the official letter!! Good Luck
— momof3
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