Pesky 40 bmi

[peacequeen 434]

My UHC plan requires 5 years bmi of 40+. I have a list of comorbs and I've rec'd 4 different doctors referrals for this surgery,,will that help?..does anyone know?

[Mabalb 0]

My UHC plan requires 5 years bmi of 40+. I have a list of comorbs and I've rec'd 4 different doctors referrals for this surgery,,will that help?..does anyone know?

I have UHC and had no probes getting covered. My BMI was 41 (5'4" 236lbs) with no comorbidities. I was reqd to show a 5 yr history of elevated weight and previous attempted weight loss. I sent the weight history, letter from my personal trainer that I saw 2x wk for a year. I heard back within a wk from the dr th my ins covers the procedures and then got my approval letter about 2 wks later. I did meet with 3 surgeons and it just happened the one that I chose was the one my ins covered. I did have to use a diff hospital (further away) than I would have chosen but it was perfectly fine. You should be fine...hope this helps!

[longer-life 139]

My UHC plan requires 5 years bmi of 40+. I have a list of comorbs and I've rec'd 4 different doctors referrals for this surgery,,will that help?..does anyone know?

Aetna lowers the BMI from 40 to 35 when the person has 1 or more of the comorbities listed. How about UHC?

Were you lower than 40 for 5 years because you were dieting? If yes, can you get proof of those diets?

Lastly, do you have proof (bloodwork etc) for the comorbidities.? I would include that, not just a letter of your PCP listing them. Hopefully they are sicknesses UHC considers comorbidities. I hope this helps.

[peacequeen 434]

I was just told that UHC required a 5 yr weight history of morbid obesity which is over 40. I've already turned in my list. I meet every other bit of criteria. I currently have a bmi of 47, my past 5 years..only 3 years were over 40 but I've been over 35 for at least 6.

I've been dieting since I was a teenager so yes I was dieting during the past 5 years . I don't know if I could get proof unless I just take pics of the books I have bought, pills I have taken, websites I have joined, fitness equip I have bought (some I have gotten rid of),,and I joined WW for a while plus went to OEA.

I have a ton of medical proof. I am on disability. However, medicare is my secondary and they don't pay for the sleeve anyway is reason I am going with my UHC. I was in the hospital 3 times this year so I'm getting my med records for my surgeon. UHC should be very aware of my comorbs, they have paid over 1/4 mil. in doctor bills for me over the past year. 2 of the physcian letters did note that I had made numberous attempts to lose the weight but had been unsuccessful. I sure hope all this helps too. Thanks yall.

[longer-life 139]

I was just told that UHC required a 5 yr weight history of morbid obesity which is over 40.

You might want to call UHC and ask if they have their requirements in writing. Aetna has it online. It will save you a lot of anxiety. Hopefully with your history, you don't even need the 5 years.

In regards to proof, had I not been diagnosed with sleep apea (which reduced it to 35 BMI), I was ready to find credit card bills for Weight Watchers, diet pills etc. Again, best wishes. I hope someone with UHC responds.

[peacequeen 434]

I'm nervous about calling them, my surgeons office said NO,,don't call them unless it came to the point where I had to appeal or something. They were handling it all,,guess that's why I'm feeling anxious about it. I have no control it seems like.

I didn't think about it but WW did automatic withdrawal from my account till I cancelled,,so did the Jillian Michaels website. Thanks for the tip.

[longer-life 139]

I'm nervous about calling them, my surgeons office said NO,,don't call them unless it came to the point where I had to appeal or something. They were handling it all,,guess that's why I'm feeling anxious about it. I have no control it seems like.

Your surgeons office will never know you called UHC to ask for their bariatric surgery requirements. Besides the insurance coordinator is not the "boss of you". You are the customer!

Granted, you want them on your side, but you are very anxious due to their lack of communication and that is not fair to you.

[peacequeen 434]

UHC is the ones that told me what they require, I called them before I started the process. Should I get it in writing? I had a hard time getting that info the first time.lol

I just wonder if anyone here has been denied due to that 5 year bmi history and if they appealed it or gave up. If they appealed what big guns did they use...I have doctor referrals, wondering if that will do the trick. Man, I just can't wait till I'm approved and get a date. I can live a normal life again..it's been almost a year of this and it's very frustrating. I know I've run this in the ground in these forums and so sorry to vent, everyone.