Definition of "morbid obesity" per insurance?

[DreamsOfSkinny 53]

What's your insurance classifying this as? BMI of 40 and beyond ONLY or either 40 bmi or 35+ bmi with co-morbidity (like the National Institute of Health defines it as)??

UHC is really trying to fight on this as my summary plan description states I need a BMI of 40 today (which I have) but I slso need a physician diagnosis of "morbid obese" for past 5 years and shoeing records.

[DreamsOfSkinny 53]

?

[Heyher 581]

CDC and medical guidelines defines it as 40+. Self funded plans follow ERISA which is federal law enacted in the 70's i believe. ERISA insurance policies tends to follow CDC definitions of morbid obesity. How your company worded the requirements is how the insurance has to enforce it. And most times the insurance plan is not allowed to deviate from the plan written by the funding company (employer).

[luvs2laff 3]

I'm with you, dreams, it's very confusing. I also have UHC but ***. My problem is that no one, not the UHC, not my medical group, nor my surgeons office can tell me, without a doubt, if I need the 6 months PCP visits. I've had the same PCP for over 15 years. I've also had my own psych for 6. My psych is writing her own letter and I'll be asking my PCP to write one also hopefully waving my last 2 months of PCP appointments. I feel my own psych knows me better than theirs and also my PCP has seen me for so long. I'll keep my fingers crossed for approval but my surgeon seems to think I'll be ok. Fingers crossed..

[CarrieP 50]

I have UHC through John deere. I know there are many different requirements and different plans. I called UHC to confirm that wls was covered. I even had them email the requirements just to be sure. Mine requires 2 years of bmi of 40 or 35 with co- morbities.

Sent from my iPhone using VST

[DreamsOfSkinny 53]

I have UHC through John deere. I know there are many different requirements and different plans. I called UHC to confirm that wls was covered. I even had them email the requirements just to be sure. Mine requires 2 years of bmi of 40 or 35 with co- morbities.

Sent from my iPhone using VST

Yeh I have email proof from them plus 6 recorded phone calls. :-/ That all didn't mean SH...T! So be careful. I included all the reference numbers and info I was given in my appeal so we'll see if it helps any.

[CarrieP 50]

Yeh I have email proof from them plus 6 recorded phone calls. :-/ That all didn't mean SH...T! So be careful. I included all the reference numbers and info I was given in my appeal so we'll see if it helps any.

What insurance do you have? Dont know why some make it so difficult. Good luck to you!

Sent from my iPhone using VST

[DreamsOfSkinny 53]

What insurance do you have? Dont know why some make it so difficult. Good luck to you!

Sent from my iPhone using VST

United Healthcare PPO ChoicePlus

[CarrieP 50]

United Healthcare PPO ChoicePlus

Ok here's the email they sent me. I have heard from some that uhc approved them in a day. I do have a $1300 deductible.

I reviewed your policy and confirmed that coverage is offered for morbid obesity. However, the coverage applies to in network providers only. The plan covers the surgical treatment of morbid obesity received on an inpatient basis provided all of the following are true.

· Covered person must have a minimum body mass index (BMI) of 40 or a BMI of 35-39.9 with at least one of the following obesity related co-morbidities.

· Cardiovascular disease including stroke, myocardial infarction, stable or unstable angina pectoris, coronary artery bypass or other procedures

· Hyperlipidemia uncontrolled by pharmacotherapy

· Type 2 diabetes uncontrolled by pharmacotherapy

· Hypertension uncontrolled by pharmacotherapy

· Moderate to severe sleep apnea with a respiratory disturbance index (RDI) of 16 to 30 (moderate) or apnea-hypopnea index (AHI) >30 (severe) as documented through the completion of a laboratory based polysomnography.

· Covered person must have documentation of a diagnosis of morbid obesity for a minimum of 2 years from physician.

· Covered person must be over age 21 and Clinical Services must be notified. To provider notification please call the phone number listed on your United Healthcare id card.

· Surgery must be performed at a network Hospital by a network surgeon. This is true even if there are no network Hospitals near the covered person.

Sent from my iPhone using VST

[oklafarmgal 31]

I have the same insurance. Also, I have bmi of 40. I just don't however have a physicians diagnosis of morbid obesity for the past five years. I have been terrible overweight, but not "morbidly obese". It have just crept up and up. I hope somehow I can get it past them. Any suggestions? Have you heard anything from the insurance yet?

What's your insurance classifying this as? BMI of 40 and beyond ONLY or either 40 bmi or 35+ bmi with co-morbidity (like the National Institute of Health defines it as)??

UHC is really trying to fight on this as my summary plan description states I need a BMI of 40 today (which I have) but I slso need a physician diagnosis of "morbid obese" for past 5 years and shoeing records.

[erp 2,016]

I have the same problem. My weight has steadily crept up to now where I have a BMI of 41-42. However, my PCP of 5 yrs left my medical group last yr, so I was without a Dr.for a year and my insurance requires a two yr history. There is a blank spot in my records but the trajectory of my weight history makes it obvious that I hit a 40 bmi last year. Any thoughts/advice?

[oklafarmgal 31]

I spoke with my insurance coordinator in my surgeons office and was told that my insurance would accept a bmi of 35 and over for the morbid obesity requirement for 5 years. I called my primary care doctor and luckily I have that. It's funny how I want heavy weights now. Lol.....But, the coordinator also said that sometimes they will use photos of yourself if they have the date on the photo to show your weight. I know it is very frustrating to work with insurance. There have been times that I have been sick and needed to go to the doctor, but didn't want to be weighed. Crazy, I know. Good luck with yours. Just talk to the insurance person in the surgeons office. They have more knowledge of what they can get the insurance to accept.

[DreamsOfSkinny 53]

I spoke with my insurance coordinator in my surgeons office and was told that my insurance would accept a bmi of 35 and over for the morbid obesity requirement for 5 years. I called my primary care doctor and luckily I have that. It's funny how I want heavy weights now. Lol.....But' date=' the coordinator also said that sometimes they will use photos of yourself if they have the date on the photo to show your weight. I know it is very frustrating to work with insurance. There have been times that I have been sick and needed to go to the doctor, but didn't want to be weighed. Crazy, I know. Good luck with yours. Just talk to the insurance person in the surgeons office. They have more knowledge of what they can get the insurance to accept.[/quote']

Thanks but my insurance is self-funded so even the bariatric policy for Uhc doesn't apply. It's just a big mess at this moment and UhC just keeps wanting me to send in letters to correct ThEIR errors--which I've done 4xs and they still haven't corrected!! I've started investigation through consumer affairs at UHC corporate as this is insane!