Question:
How long must I be a MO person before I qualify for WLS?

I have been at least 75-85 LBS overweight for 7 years. But have been 125 LBS overweight for 1 1/2 years. I have a lot of Co-Morbs, and a huge family history of Co-Morbs of MO Family Memebers. I have an extensive weight loss attempt history as well. My concern is that I haven't been MO for very long. (1 1/2 years is long enough!) My Insurance says it has to be medically necessary, but that is all they tell me. So I have no idea if they have this 'exclusion'. How about your insurance? (even though they may be different). I was just wondering what the general rule is... Thank You    — [Anonymous] (posted on May 17, 2001)

May 17, 2001
Depends on your insurance carrier. I was approved by Aetna HMO and have only been 100lbs overweight for about a year, but have always been 75 - 90lbs overweight. I do know that BCBS has a policy that you have to be MO for FIVE years! Call your insurance carrier--they'll usually tell you what their criteria is. When I first started researching, I had Guardian PHCS PPO and they required that you be 200% over your ideal weight. All insurers are different, it seems.
   — PT LawMom

May 17, 2001
I don't think there is a "time line". You say that you have several co-morb conditions and this will be what determines if it is medically necessary. If this is what you want to do, talk to your doctor.
   — Donna A.

May 17, 2001
I don't know about you but one day of being morbidly obese is too long! It shouldn't be the length of time you've been mo - it should be that you are - PERIOD! The necessity of having surgery is that you are mo and that you have comorbidities to substantiate it. Insurance companies need to get a life! Good luck and God bless!
   — Sharon R.

May 17, 2001
My insurance is BC/BS PPO and it states you must be overweight for 5 years, not MO. You do quality for surgery alone with being MO (100 lbs. overweight at the time you request surgery. You do not need to be this weight for five years however. Good luck!
   — [Anonymous]

May 17, 2001
My insurance company also stated only that it must be medically necessary but they denied both me and hubby because we had not been 100 pounds overweight for 5 years. However, they approved us on the first appeal less than 1 week later! Hubby had never been 100 pounds overweight. If you're denied, fight and don't give up. Good luck!
   — Anika R.