I have a BMI of 42. I was told and recieved a copy of their benfits as followed please tell me if I am wrong but I should be fine for insurance approval based on my BMI and I have tried several different weight loss programs.
Thanks,
Kelly ( ST. LOUIS)
Coverage:
The following criteria and guidelines have been developed to judge eligibility for coverage of bariatric surgery for the treatment of morbid obesity.
To be considered eligible for benefit coverage of bariatric surgery for treatment of morbid obesity, the following three criteria must be met:
A diagnosis of Morbid Obesity, defined as:
Body Mass Index (BMI) of greater than or equal to 40 kg/meter squared; OR
BMI greater than or equal to 35kg/meters squared with at least two (2) of the following co-morbid conditions which have not responded to maximum medical management and which are generally expected to be reversed or improved by bariatric treatment:Hypertension,
Dyslipidemia,
Diabetes Mellitus,
Coronary heart disease, and/or
sleep apnea.
At least a five-year history of Morbid Obesity supported by medical record documentation.AND
It is expected that appropriate non-surgical treatment should have been attempted prior to surgical treatment of obesityNon-surgical treatment of morbid obesity appropriateness criteria:
Medical record documentation of active participation in a clinically-supervised, non-surgical program of weight reduction for at least 6 months, occurring within the twenty-four (24) months prior to the proposed surgery and preferably unaffiliated with the bariatric surgery program. [NOTE: The initial BMI at the beginning of a weight reduction program will be the “qualifying” BMI used to meet the BMI criteria for the definition of morbid obesity used in this policy.]
A program will be considered appropriate if it includes the following components:Nutritional therapy, which may include medical nutrition therapy such as a very low calorie diet such as MediFast or Optifast OR a recognized commercial diet-based weight loss program such as Weight Watchers, Jenny Craig, etc. (TRIED BOTH)
Behavior modification or behavioral health interventions.
Counseling and instruction on exercise and increased physical activity.
Pharmacologic therapy (as appropriate).
Ongoing support for lifestyle changes to make and maintain appropriate choices that will reduce health risk factors and improve overall health.
