2 yr Weight History

[StacyS 20]

Hi... I'm right at 40 BMI and actually had to gain weight in order to get to 40. I have BCBS-Fed and they require a 2 year weight history. Well, I have the history however my history only reflects me being at 36-38 BMI and I was wondering if anyone was denied by their insurance due to not being the 40BMI for more than 2 years??? I dont have any co-morbidities but I do have GERD and a Hiatal Hernia but no diabeties or HBP. Any experience??

[fatBgone 6]

Hi... I'm right at 40 BMI and actually had to gain weight in order to get to 40. I have BCBS-Fed and they require a 2 year weight history. Well, I have the history however my history only reflects me being at 36-38 BMI and I was wondering if anyone was denied by their insurance due to not being the 40BMI for more than 2 years??? I dont have any co-morbidities but I do have GERD and a Hiatal Hernia but no diabeties or HBP. Any experience??

Hi StacyS, unfortunately I was denied. I started my process last year around Feb, I went through the medically supervised diet for 3 months, which is what my insurance requires. My BMI is between 35-40 and I do have 2 comorbidities (high blood pressure and cholesturol) Even with that, my insurance denied me. Its actually not the insurance but my employer who sets the limit as to what will be accepted for this type of surgery and they are very strict on the BMI of 40. I was pursueing a lap band at the time and even worked with Obesity Law and they appealed my denial. It took from May, 2010 - Jan 2011 to go through all the appeals and ultimately I was still denied. I decided to move forward and self pay so here I am. Waiting on Apr 11!

I had all my medical records for the last 5 years showing BMI of at least 35 and all the medication for HBP and cholesturol, plus a reccommendation letter from my regular doctor saying I would benefit from a lap band but didn't matter. Good luck to you. Hopefully you will have a better outcome.

[StacyS 20]

O no, that's not very encouraging...but the fact that it was your employer rather than insurance who denied you gives me hope. I'm happy you can afford to self pay as I cannot if I'm denied!!

[Amber 4]

I have Anthem BCBS and I had to gain a litte weight also. So I haven't been at a BMI 40 in my doctor checkups. I have my appointment for the tests next Wednesday so they can submit it to insurance. I've been wondering about the same thing. How far are you into the process of getting surgery?

[fatBgone 6]

O no, that's not very encouraging...but the fact that it was your employer rather than insurance who denied you gives me hope. I'm happy you can afford to self pay as I cannot if I'm denied!!

I didn't mean to discourage you! Just relaying my story, which sucks!!! Anyway if you are denied, make sure you look at your options for self pay. Many people on this site went to Mexico for surgery because of cost and I know most doctors offer CareCredit which allows you to finance the cost.

[Was a humpty dumpty 35]

If you are denied write a grievance letter and submit it to your insurance grievance dept.State all your medical conditions and family history of heath problems.

Also be very firm (don't come across as passive) , state you were unfairly denied and that you will file a compaint with Department Of Managed Health Care (DMHC) - the state agency in California authority to regulate all health care plans. http://www.dmhc.ca.gov (888) ***-2219 or (800) 400-0815.

Goodluck

[StacyS 20]

Let's hope it doesn't come to that, but thank you for the info just in case!!