Required 3 years of medical records

[darby0375 18]

One of the stipulations of my insurance (BCBS of AL) is that the qualifying BMI (35) has been persistent for 3 years. I called my PCP and got my weights from 2011-2014 and I have 1 weight that wouldn't qualify...all the others are no problem. The other part that sucks is that the low weight/BMI was from 2013, so if I can't get approved now, then it will be several years. I found this out yesterday and had the biggest pity party, complete with crying for a good 30 minutes lol.

After I got my composure, I started trying to think of a solution. I am wondering if I went back further than 3 years that it would be enough to document my history. Would a letter from my PCP help my chances of getting approved? A letter from me? I'm going to email the insurance coordinator for my surgeon on Monday to see if she thinks any of this will help. Any suggestions or advice from you all would be much appreciated!

Edited December 26, 2014 by darby0375

[wannaBthinsoon 1,634]

hi @@darby0375 Doesn't look like too many folks have either read your question, or maybe don't know how to answer. I don't think you need to worry about that one year. From what I understand, it's just a hoop to jump through for insurance purposes. I had to gather 5 years of weight history. 5 years ago my BMI was 33, 4 years ago it was 35, 3 years go it was 37, 2 years ago it was 40, Now it's 42. I see a trend, what do you think?. Also, I'm sure the lower BMI can be explained by a diet or two you may have been on at the time. I wouldn't sweat it.

Edited December 28, 2014 by wannaBthinsoon

[darby0375 18]

Thanks for responding. I guess I always tend to expect the worst, so jumping through all these hoops and getting denied at the end would likely be my luck. If it happens, I guess there's always the option to appeal.

[Jersrose43 837]

Maybe you were on a diet during that period and failed. Clearly they can see that it failed. Your pcp when he writes recommendation letter should clearly refer to that period of let down and reason you need surgery

[getnfit52 12]

Check to make sure they recorded your height right as that is what gave me a lower bmi in 2013. But could show that I was a inch shorter the next week thru Dr records, so I was above the 35 bmi.

[heatherfit4life2b 1]

From what I understand this is something that the peer to peer "appeal" should help with. Your surgeon could explain that one-time weightless.

[mykdzmom 387]

OMG!! This is me too.... I was just in hopes that if (heaven forbid) I am not approved, that my PCP could appeal and still get approval. I also liked the comment about having PCP note that in the recommendation letter. Good luck!

One of the stipulations of my insurance (BCBS of AL) is that the qualifying BMI (35) has been persistent for 3 years. I called my PCP and got my weights from 2011-2014 and I have 1 weight that wouldn't qualify...all the others are no problem. The other part that sucks is that the low weight/BMI was from 2013, so if I can't get approved now, then it will be several years. I found this out yesterday and had the biggest pity party, complete with crying for a good 30 minutes lol.

After I got my composure, I started trying to think of a solution. I am wondering if I went back further than 3 years that it would be enough to document my history. Would a letter from my PCP help my chances of getting approved? A letter from me? I'm going to email the insurance coordinator for my surgeon on Monday to see if she thinks any of this will help. Any suggestions or advice from you all would be much appreciated!

[wannaBthinsoon 1,634]

Luckily my insurance ,UHC, doesn't have that requirement anymore. Check with your insurance co. The Bariatric center I am going to tried to tell me I'd be denied due to the low BMI's. But I called the insurance co and it is no longer a requirement. YAY for UHC