Nikki613 120 Posted April 3, 2012 I went for my first appointment today and the insurance coordinator told me all the necessary things I need for my insurance to cover surgery. I have a bmi of 41 at the moment, but no other issues. Problem is my isurance (Cigna PPO) requires my BMI to be 40 or over for the last two years. Well it hasn't been. I got married last year and the 2 years prior I was dieting hard core so my weight up and down and my BMI was probably only 37-39 at any of my Dr's visits.When I got engaged a couple years ago I was around 230lbs, then off and on over our engagment I bounced around from 200-230lbs. On my wedding day I weighed 216. Now I am up to 250lbs a year later. I am so disaHe surgeons office wants me to do all these tests and they want me to continue with the 6 month supervised diet and hope that we can get me approved, but now I am thinking it will really suck to go through all of it and be denied. Has anyone else had this 2 year weight history over 40 BMI be an issue even if they were only a couple points off? Just want to know the good the bad the ugly. Share this post Link to post Share on other sites
VeeBee 0 Posted April 4, 2012 I didn't have the physician's documented weight loss either because I avoided doctor's offices, but my insurance company said they would accept pictures of me as proof that I was obese from the time period in question. Wonder if yours would do the same? I think they mostly want to be sure that you have had weight problems for a long period of time versus someone who has been thin all their life and then suddenly put on weight and decides to have surgery so your doc's office is probably right and they can get it approved for you even if you don't fall into the exact range. Its worth a try. I am 10 weeks out and down 40 lbs since surgery. I had a lot of hoops to jump through as well, including the six month supervised diet/wellness classes. Just jump through one hoop at a time!!! Share this post Link to post Share on other sites
Nikki613 120 Posted April 4, 2012 How did you prove the time period of the pictures? I have been batteling my weight for about 7-8 years. I pretty much avoided pictures and the few i do have don't dates on them? Share this post Link to post Share on other sites
IMSKINNY 160 Posted April 4, 2012 My doctor only required several office notes from my PCP for the 3 years in question. So, we chose the office visits with the highest weights. Try that... Share this post Link to post Share on other sites
vsggal 1 Posted April 5, 2012 I went for my first appointment today and the insurance coordinator told me all the necessary things I need for my insurance to cover surgery. I have a bmi of 41 at the moment' date=' but no other issues. Problem is my isurance (Cigna PPO) requires my BMI to be 40 or over for the last two years. Well it hasn't been. I got married last year and the 2 years prior I was dieting hard core so my weight up and down and my BMI was probably only 37-39 at any of my Dr's visits.When I got engaged a couple years ago I was around 230lbs, then off and on over our engagment I bounced around from 200-230lbs. On my wedding day I weighed 216. Now I am up to 250lbs a year later. I am so disaHe surgeons office wants me to do all these tests and they want me to continue with the 6 month supervised diet and hope that we can get me approved, but now I am thinking it will really suck to go through all of it and be denied. Has anyone else had this 2 year weight history over 40 BMI be an issue even if they were only a couple points off? Just want to know the good the bad the ugly.[/quote'] Oh wow! This is exactly what I'm scared of!!!! My insurance is B/S of California and we are covered by Bariatrics, but I keep hearing stories like your! Hummmm...let me know how the process goes!!! Share this post Link to post Share on other sites
DianaDominate 4 Posted April 8, 2012 Don't worry they asked me for a 5 year weight history and I only recently had a bmi of 40 or higher and I just got approved! 1 vsggal reacted to this Share this post Link to post Share on other sites
JustSleeveMe23 15 Posted April 24, 2012 How did this turn out??? Share this post Link to post Share on other sites
Nikki613 120 Posted May 1, 2012 How did this turn out??? Well I cancelled all my upcoming appointments today. Went to dinner tonight and checked my voicemail and the insurance coordinator left me a message. As of this month cigna has not been requiring the weight history beyond that of the 6 month diet. Im excited! Now we have to figure out if we can afford the deductable Share this post Link to post Share on other sites
JustSleeveMe23 15 Posted May 2, 2012 I am SO happy to hear that! Thanks for updating!! And I say, go for it! They probably won't force the deductible up front and you can make payments on it. I wouldn't let a deductible hold me back! Share this post Link to post Share on other sites
Nikki613 120 Posted May 2, 2012 I am SO happy to hear that! Thanks for updating!! And I say' date=' go for it! They probably won't force the deductible up front and you can make payments on it. I wouldn't let a deductible hold me back![/quote'] I dont think my surgeon requires it upfront but the hospital may require some or all of their portion. I am not sure. I left a message for the coordinator to cal me tomorrow. Share this post Link to post Share on other sites
Nikki613 120 Posted May 16, 2012 Another Cigna revision, they no longer require 6 months supervised diet. Now its only 3!!! My third appointment is early June. Finish all my testing mid June, my guess is we will be submitting to Cigna in about 5 weeks. Yikes!!! Im super excited! Just hope it all works out. 1 fell4falls reacted to this Share this post Link to post Share on other sites
fattymcfatterson 107 Posted May 16, 2012 I see you are in Fort Worth.... Do you have a max out of pocket and how much is your deductible? I went through Dr. David Kim and he required a sleep study. The sleep center he used accepted what the insurance paid as payment in full. That covered my "out of pocket max" of $2200 and the $500 for my out of network deductible. If you have any questions feel free to pm me. What surgeon are you using? Share this post Link to post Share on other sites
