Question:
Anyone get approval without being 100 lbs over for 5 years?

I have a BMI of 40 and am over 100lbs my ideal body weight for about 2 years. I have several comorbidities: hypertension,high glucose, cholesterol,triglycerides, stress incontinence,shortness of breath, chronic pain of weightbearing joints,depression and anxiety, edema, heartburn...Will this be enough to have them make an exception to the 5 yr. rule?    — janie K. (posted on August 7, 2001)

August 7, 2001
What exactly does your insurance say they want? Mine only wanted me to prove that I had been on a "medical supervised diet" for 1 year - but not necessarily morbidly obese - I only had to be morbidly obese to be considered at the time of surgery - it is all based on how your policy is worded.
   — Sharon Jones

August 7, 2001
Is the "5 year rule" in your insurance policy? I heard of this rule from a few people on this site, but I believe it is specific to a particular insurance company (which one I don't know). It is not a general rule. I had a BMI over 40, I did not have to have been on a medically supervised diet or have to meet the 5 year rule. I had my surgery 1.5 years ago and only recently have heard of this.
   — Gina E.

August 8, 2001
I HAVE CIGNA AND THE ONE MAJOR RULE WAS A BMI OF 40 FOR NO LESS THEN 5 YEARS, BUT IF YOU HAVE COMORBIDS AND 100LBS OVER THEY SHOULD APPROVE SURGERY FOR YOU. THERE ARE WAYS AROUND THIS HANG IN THERE. JUST DON'T GIVE UP IT TOOK ME ALMOST 1 YEAR TO GET TO SURGERY, BUT I MADE IT SURGERY SET FOR OCT.
   — PAMELA T.

August 16, 2001
Hi..! My Ins. Co. is Medical Mutual of Ohio (Super Med Plus). Their requirement was "100 lbs overweight for period of 5 years, with PCP documentation for that period". When I went to my consultation, I was only 89 lbs overweight (I am, after all, only 5 feet tall - 10 pounds extra shows BAD on me! lol), and the "documentation" I turned in from my Dr. was a just sheet of paper from one of those notepads that the drug reps leave for the staff, with the years and maximum weight recorded. It was stamped and signed by the office staff. HOWEVER, my co-morbidities include arthritis, edema, joint pain, fatigue, already had to have gall bladder removed, already had to have bladder suspension to correct stress incontinence... etc. My surgery was APPROVED with the first fax.. it took about 5 weeks for me to get my copy..!! I'm waiting on a surgery date SOON! Sooooo...obviously my co-morbidites outweighed (no pun intended) my "not being fat enough" (what a JOKE that is..!!). Keep the faith.. if this surgery was meant for you... it will HAPPEN..! God bless..and good luck!!
   — Diane E.

August 26, 2002
i HAVE MEDICAL MUTUAL AND THEY HAVE THE 5 YEAR 100LBS OVER IDEAL BODY WEIGHT & A BMI OF 40. IAM 100LBS OVER WEIGHT. I HAVE BEEN 90-100LBS OVERWEIGHT FOR THE PAST 5 YEARS. MY BMI HAS RANGED BETWEEN 32-40. I HAVE SEVERAL COMORBIDITIES. I WAS DENIED THE FIRST TIME. I AM NOW IN THE PROCESS OF MY FIRST APPEAL. I HOPE THEY WILL APPROVE THE SURGERY THIS TIME. I WILL FIGHT THEM IF THEY DON'T UNTILL THEY DO BECAUSE I CAN'T LIVE LIKE THIS. JUST FIGHT. IT'S YOUR LIFE. SOMETIMES THEY NEED REMINDED OF THIS, I THINK.
   — SHERRIE S.

September 26, 2002
My ins compay policy states the same thing. I have been 100 pounds overweight for 3 years, but overweight since the 5th grade. I was approved this morning. Unless they specifically ask for your weight charts for the past 5 years, they have no way of knowing that. I had to give 2 years of medical notes.
   — Cynthia A.

September 26, 2002
I was not 100 pounds overweight for long- but I had gained 70 pounds in 3 years and the MD agreed that if I continued at that rate- I was headed for trouble- though I had always been "heavy" typically I was 50-70 pounds over at any given time- Often losing it on one fad diet or another-
   — ~~Stacie~~

September 26, 2002
Hi, my insurance company(according to the web site) said I had to be 100 lbs overweight for the 5 years. I wasn't and was still approved just in August. And, my BMI was barely 40, so sometimes they will approve you even if you think it is unlikely(as I did!lol).
   — Helenjean P.