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!

[Elode 8,093]

My insurance co required 2 years BCBS fed. And I only had two documents both with a BMI of around 32! I have no co-morbids and they approved me. I was suppose to show two years at a BMI of 40. I was 40 at my first weigh-in though.

[darby0375 18]

The way my policy is worded is that there will be random reviews of medical records. I guess the insurance coordinator has seen instances where a patient was selective with what records they provided and surgery was approved...then BCBS did a random review and found a disqualifying BMI. I just don't want to go through all this then either get denied or have the surgery then get a ginormous bill.

Edited December 26, 2014 by darby0375

[Elode 8,093]

@@darby0375 They will have to approve you first and once your approved they can't come back and bill you. It is a chance as far as being approved or not that you will have to take if you want to find out. You can write a paper to submit with your paper work as to why your weight was lower...like dieting. That's what I did! My BMI was 32 but I also was getting married and practically starved my self to get skinny for my dress ugh! But a lot of women do and they know that. They also required that I write down every diet that I had tried in the two years, well obviously if I'm dieting I'm losing weight. That wasn't the problem the problem was I couldn't keep it off! Which is why after My wedding within a year I had put on 50+ lbs and my BMI was 40.

[Sharon1964 2,530]

I would wait to see if you get a denial for that reason. There is a possibility that the medical assistant entered the wrong weight into your records that one time. That is probably what I would base my appeal on.

Oh, and as stated above... if you have a medical procedure based on an approval, they cannot come back later and retro-deny that approval. As long as your insurance is current (paid up) at the time of the procedure, and they have not notified you that they have rescinded the approval BEFORE you have the surgery, you're fine.

Edited December 26, 2014 by Sharon1964

[twinsdad30067 4]

I have BCBS (AL) ans started in May of 2014, got wrong advice and had to start my six months of documentation over again, they dont have to give every single weight in 2013, do you have any that was above the limit? Im supposed to have my surgery in April....

[darby0375 18]

Oh yeah, lol. All my weights back to 2008 would be a BMI of at least 35. I'm feeling a little better about my situation. That really stinks that you had to start your 6 months over. Where are you now in the process?

[AquariusDiva 15]

I had a similar issue, including a low bmi one year and a missing bmi for another year. My insurance denied the WLS. So my surgeons office filed an appeal, and it was approved on 12/15. Unfortunately my surgeon was on vacation for the last two weeks of dec. and as of today, 1/1/15, we have a new insurance. So now I'm waiting for the new insurance to approve it again.

[downsizingdiva 459]

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!

Mine needed 5 years medical record weights. I would definitely keep working on it! You'll get there!

[jersey_girl_86 61]

My PCP doctor had to write a date and weight from 2011,2012, and 2013. I was pregnant most of 2012 and I am hoping that doesn't cause any issues.

[jersey_girl_86 61]

My PCP doctor had to write a date and weight from 2011,2012, and 2013. I was pregnant most of 2012 and I am hoping that doesn't cause any issues.

[twinsdad30067 4]

I have a visit for Jan 26, Feb 25, and March 25! Then I will be completely finished and just waiting on my surgery date.

[twinsdad30067 4]

Who is going to perform your surgery??

[darby0375 18]

Dr. Miles at Alabama Weight Loss Surgery in Birmingham.