Medical Necessity?

[JessVotedBest 0]

Hi everyone! I'm new to all of this. I recently decided that I wanted the Lap Band. I have a BMI of 40 with no comorbidities. When I spoke to my insurance, they said they would cover it 100% but mentioned it must be medically necessary. What does that mean? I have no known medical conditions other than being 100 pounds overweight. Then the lady said I am not required to diet for 6 months or anything, I just need a doctor's authorization. Will the doctor most likely require that I do on a supervised diet first? I wanna get this done as soon as possible.

[mkfearnow 0]

Do you snore? If you do, you may have sleep apnea. See about setting up a sleep study and getting a CPAP machine. It might take a month or two, but so does the process of qualifying for a band what with the paper work, doc visits, psych evaluation, and insurance approval.

I have a BMI of 38 and 100 lbs over-weight. I have sleep apnea and PCOS, both which qualify for the surgery. I'm getting my band June 6, and totally looking forward to it.

Best of luck!!

[Humming Bird 275]

Hi everyone! I'm new to all of this. I recently decided that I wanted the Lap Band. I have a BMI of 40 with no comorbidities. When I spoke to my insurance, they said they would cover it 100% but mentioned it must be medically necessary. What does that mean? I have no known medical conditions other than being 100 pounds overweight. Then the lady said I am not required to diet for 6 months or anything, I just need a doctor's authorization. Will the doctor most likely require that I do on a supervised diet first? I wanna get this done as soon as possible.

With a BMI of 40 or more we/you are morbidly obese and that alone makes it a medical necessity. It sounds like all they need is a short letter stating that from your PCP. If your PCP is not on board with that, find one that is. Good luck to you

[54Shirley 105]

You are 100lbs. over weight that alone is Medically Necessary as far as a Bariatric Surgeon's Diagnoses. Also ask your Primary Dr.'s Opinion.

Let them know your knees Joints are starting to hurt, and they feel stiff sometimes. That is a definite sign that you are to heavy. You won't be denied by the Ins. Co....

[Cocoabean 430]

I agree with what Humming Bird said. They want a letter from a doctor stating that you need the surgery as a treatment for your obesity. A BMI of 40 or over is morbid obesity and a disease in and of itself.

[JessVotedBest 0]

Thanks you guys!