Insurance requiring 5 years of consecutive diagnosed obesity! Anyone else have this in their policy?

[shasha1974 4]

Hi guys!! I have anthem bc/bs of Maine individual policy and just found out today that they require the 5 year medically diagnosed obesity! I have just gotten insurance in March as I am self employed and don't have these years of documentation! I'm just curious if anyone has had this same requirement! Thanks a bunch

Shawna

[Inner Surfer Girl 12,015]

Have you been to any doctor in the last five years (GYN, clinic, primary care) where your weight was recorded?

[lsmith715 55]

That was one of my insurance requirements. I basically just had my doctor send a list of recorded weights from past visits.

[shasha1974 4]

I've been self employed or worked as a nanny/household manager in which the job didn't provide insurance and I wasn't able to afford it. I have seen a doctor and gyn probably 7 years ago and also a visit here or there to quick care but don't have 5 years of consecutive visits! I'm afraid this may kill any chance of approval for me

[Inner Surfer Girl 12,015]

Get the records you do have and then see if your current PCP will write a letter on your behalf. Don't give up before you have even started.

[GBLady41 393]

I'd try to get every visit you've had. And definitely use the visit with your gyn 7 years ago. That way, it will show that you have had a problem for at least five years. My insurance wanted that too.

[shasha1974 4]

Thanks ???? I assumed it had to be consecutive! That they would want a weight for each year! I'm new to this whole insurance thing so it's all very confusing

[betrthnever 107]

BCBS is requiring that I have 5 years of a BMI of 40 before I can switch from the Lap Band to the RNY! IWell I can't show that because I had WLS 7 years ago! 2 years after my surgery I was the lowest, but then I started to gain. Had my first denial back in November, 2014. I'm probably going to get my second soon. I will contact lindstrom obesity advocacy.

[shasha1974 4]

They really make you jump through the hoops!! Which I can understand to a point but I think a lot of it is so they don't have to pay! I'm going to meet with an independent agent November 9th and he's finding me a plan and policy that doesn't have this requirement doing can switch when it's open enrollment time November 15th and the new policy will go into effect January 1st. That's right when is be finished with the 6 months medical supervised weight loss. Hope it works!

[GBLady41 393]

I hope it works too. Good luck!

Edited August 21, 2015 by GBLady41

[Cervidae 2,389]

Hi guys!! I have anthem bc/bs of Maine individual policy and just found out today that they require the 5 year medically diagnosed obesity! I have just gotten insurance in March as I am self employed and don't have these years of documentation! I'm just curious if anyone has had this same requirement! Thanks a bunch

Shawna

my insurance actually required the same thing, and I had the same issue you did, no insurance for a long time before I started this process. All they ended up needing was paperwork filled out with my primary care doctor and signed by her in which I tell her I have been obese for about ten years. Some things need documentation but a lot of insurances will take your doctor's word for it, and your doctor will take your word if you are open and honest with him/her. Hope this helps and is the case for you! Good luck, keep us posted.

[shasha1974 4]

Thanks so much everyone for all the kind replies!! I so hope this is the case with my insurance! What do you have for insurance? I have anthem, and the thing that concerns me is their wording "5 years consecutive" diagnosis! Eeek I hope and pray they'll take the verification from my doctor as this documentation! That would save a lot of hassle for me! It's great to hear there is still a chance though ???? I have my meeting with the social worker Monday so I'll talk more with the office about it too! I'll let you know how it goes

[shasha1974 4]

I'd try to get every visit you've had. And definitely use the visit with your gyn 7 years ago. That way, it will show that you have had a problem for at least five years. My insurance wanted that too.

did you have to provide documentAtion for each year, or where they ok with some kind of documented weight during that time? I just wonder how picky they will be! If I have to have a weight for exactly each of the 5 years or if my doc can just diagnose it...

[Cervidae 2,389]

@@shasha1974 definitely keep us updated. Positive thoughts.

[GBLady41 393]

I'd try to get every visit you've had. And definitely use the visit with your gyn 7 years ago. That way, it will show that you have had a problem for at least five years. My insurance wanted that too.

did you have to provide documentAtion for each year, or where they ok with some kind of documented weight during that time? I just wonder how picky they will be! If I have to have a weight for exactly each of the 5 years or if my doc can just diagnose it...

No. On my form there were spaces for weights and then one space for my weight five years ago. So I filled in the spaces with my previous visits and then filled in the one that was at least five years ago. But I also think that if you talk to your doctor, he/she will understand and give you what you need in order to get your surgery. Keep us informed. ????