Help

[JillianRN 0]

I posted this in another thread..would those of you that have been insurance approved tell us what your BMI was and if you had co-morbidities...This would help us so much as we wait to be approved..Tks!

[ICUnurserachel 17]

I had a BMI of 42 and hypertension. It too 6 mos and 2 denials to get through the approval process. I see you are from NC. Who is your doc?

[ziggledog 0]

Hi. Age 46; BMI was 37. Dyslipidemia, mild hypertension. Approved on first request.

[reverie 49]

My BMI was 43. Didn't need to have any comorbidities.

[Portola Suzanne 3]

Age 54, BMI 36 joint problems and one other thing can't remember what it was. Approved first time.

[BetsyB 9]

You can take the guesswork and suspense out of waiting by reading your policy; it will spell out, very precisely, the conditions you have to meet.

Mine specifies that for BMI 35-40, 2 comorbidities are required in order for banding to be covered.

For BMI > 40, no comorbidities are necessary.

At my first preop visit, I was just at 40; this is the number that was used for approval. However, by the time I hit the OR, I was lower than 40.

[Bryn 3]

I had a BMI of 42 and hypertension. It too 6 mos and 2 denials to get through the approval process. I see you are from NC. Who is your doc?

If you don't mind me asking, why did you get denied twice?

according to majority of policies, folks with a BMI of 40+ are generally approved. did they state the reasons?

sorry, i'm just curious

[gogtigirlgo 0]

You can take the guesswork and suspense out of waiting by reading your policy; it will spell out, very precisely, the conditions you have to meet.

Also, you'll want to check with your employer's summary plan description if your policy is with your employer. Most times you can get an SPD from your HR/Benefits office, or they can at least direct you where to go to get it online.

I haven't been approved yet, and ran into a snag when the Insurance Co. was not aware that my employer changed rules this past January. It didn't come up until everything was being submitted for approval and I did some digging through the SPD to find what they were talking about. In fact, if I were to call the insurance company tonight to find out what the requirements were they would tell me the only thing I need is a BMI over 40 or over 35 with co-morbidities.

Edited August 26, 2010 by gogtigirlgo
Adding a sentence :)