Required 2 Year Weight History?! Uh Oh.

[Nikki613 120]

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.

[VeeBee 0]

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!!!

[Nikki613 120]

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?

[IMSKINNY 160]

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...

[vsggal 1]

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!!!

[DianaDominate 4]

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!

[JustSleeveMe23 15]

How did this turn out???

[Nikki613 120]

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

[JustSleeveMe23 15]

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!

[Nikki613 120]

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.

[Nikki613 120]

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.

[fattymcfatterson 107]

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?