Ins approval without medical record of morbid obesity?

[Missvicky388 0]

Hi, everyone. I'm a newbie who has been lurking on the forums for the past month or so. You all are amazing and I am so grateful for your candid comments and generosity of information.

I have my first seminar next week so I am trying to get my ducks in a row. My insurance does cover banding so I am very fortunate (horizon bc in nj). However, I am a little concerned about whether my lack of medical treatment records might impact the insurance decision. I do not have pcp, haven't seen a doctor in a number of years. I dont have anything "official" documenting my weight and weight loss efforts. I have a few years of cardiovascular screening records, including my weight, from my job. Do you think i can use that proof? I guess I've benn avoiding medical testing and treatment all these years because I just didn't want the doctors to make me feel any worse than I already felt. Not sure if anyone else has been through this. Thanks for any help.

[megamomnj 334]

I was banded in November and also have horizon bcbs of nj. For me, they required all the mandatory testing (EKG, psych, upper GI, etc) and three months of weight check ins with my PCP. I have a friend who is doing the weigh ins with a nutritionist.

Hope this helps!

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[ksaug21 81]

Do you know exactly what your insurance will want to see? Some insurances are very different. Have you been to an OBGYN yearly? They would have your weight for each visit? I had my doctor write a letter stating my weight for the past two years while seeing him for various things, like bronchitis, etc. It wasn't an "official" medical record but a letter that he wrote and then he stated in the letter that he felt was a good candidate for the lap band.

Find out what your insurance will/will not accept.

[Missvicky388 0]

Thanks, ladies. I'm anxious to get going and your comments are a big help.

[CHEZNOEL 4,061]

I suspect you will have some period of medically monitored diet prior to approval, but all insurance is different. BUT!!!! Once banded, you cannot ignore your health, plan on regular doctor visits!

[labwalker 1,177]

Make sure your doctor's office (his staff that handles the insurance claims) is exactly on the same page as your insurance company's requirements. There was a poster on here who went through the required six visits with the surgeon's NUT, in his office, but the insurance company was denying because the doctor didn't some required paperwork or record keeping for each visit. I don't remember the particulars... but insurance companies can be a real pain to deal with.

[Missvicky388 0]

I suspect you will have some period of medically monitored diet prior to approval, but all insurance is different. BUT!!!! Once banded, you cannot ignore your health, plan on regular doctor visits!

Thanks. Part of the "pro's" for the band is the built I accountability. I never want to be in the dark Orin denial about my health again.