Just checked my Insurance's January 2014 policy for Bariatric Surgery

[islandgal65 36]

I don't see anything about a six month nutrition. Keeping my fingers and toes crossed it goes smoothly, I have my Surgeon Consultation on January 10th. I cannot wait to get this weight off for good, my BMI is 48

Bariatric Surgery: Clinical Policy (Effective 1/01/2014)

©1996

-

201

4

, Oxford Health Plans, LLC

2

Note:

Gastric electrical stimulation with an implantable gastric stimulator (IGS) for the treatment

of obesity is addressed in this polic

y. For information regarding other indications, refer to

Gastrointestinal Motility Disorders, Diagnosis and Treatment.

COVERAGE RATIONALE

Required Documentation for Medical Director Review:

•

Office notes including medical history and/or a letter of medical necessity.

Bariatric surgery, as a primary treatment for weight loss

is medically necessary for the following:

1.

Class III obesity (BMI

≥

40 kg/m2)

;

2.

Class II obesity (BMI 35

-

39.9 kg/m2) in the presence of one or more of the following co

-

morbidities:

o

Type 2 diabetes

o

Cardiovascular disease (e.g., stroke, myocardial infarction, ,

poorly contro

lled

hypertension

(systolic blood pressure

greater than 140 mm Hg or diastolic blood

pressure 90 mm Hg or greater, despite pharmacotherapy)

o

History of coronary artery disease with a surgical intervention such as

cardiopulmonary bypass or percutaneous tran

sluminal coronary angioplasty

o

C

ardiopulmonary problems (e.g.,

documented obstructive

sleep apnea

(OSA)

confirmed on polysomnography with an AHI or RDI of

≥30 (as defined by AASM Task

Force. sleep. 1999; 22: 667

-

89)

o

History of cardiomyopathy

[LindafromFlorida 1,542]

Good luck! Your doctor's Office staff are the experts on the requirements of the insurance thank goodness. I wish you the best. Which procedure are you looking at?

[islandgal65 36]

Good luck! Your doctor's Office staff are the experts on the requirements of the insurance thank goodness. I wish you the best. Which procedure are you looking at?

Thank you Linda...I would like the sleeve.

[LindafromFlorida 1,542]

I was done 11/18 and best thing ever! My husband and I went to seminars for 10 years looking at everything, but would not do the other options. Very glad we had the sleeve. Wish we could have had it in our 50s, no mid 60s! Good luck!!!!

[Lioness813 52]

<p>I was done 11/18 and best thing ever! My husband and I went to seminars for 10 years looking at everything, but would not do the other options. Very glad we had the sleeve. Wish we could have had it in our 50s, no mid 60s! Good luck!!!!</p>

Congrats on your success Linda! Would love to hear about your journey...any tips or advice! I'm being sleeved on 1/29. Thx

[Ballermom 803]

Good luck!

My BMI was 41 with few co morbidities so you should be good. I'm 10 months out