Will I be covered?

[Mom2Axel 0]

I am 22 with a BMI around 48-50. I have been overweight my whole life. I had my gallbladder removed in 2000 and the doctor said I had a fatty liver that will lead to future problems.

I don't have a record of past diets (never did them with a doctor), and I have not ever been diagnosed with with back pain or GERD even though I have them.

They said they need proof of being morbidly obese for 5 years. How do I get that?

[Jodi_620 37]

Have you visited your doctor on a fairly regular basis over the past five years? They usually take your weight at each visit so they would have that in their records.

[Mom2Axel 0]

No, I have not visted a doctor consitantly over the last 5 years. I had surger in 2000, to have my gallbladder removed. In his records he did note my liver was overly fatty (i have been overweight my WHOLE life), I was in the ER around 3 -4 years ago for a UTI, and in 2007 I became pregnant and started seeing a doctor regular after that point.

[jrob281 1]

So other than gall bladder surgery and follow up, the ONLY times you were at a Dr was for pregnancy? Wow, you must be healthy.

Which insurance co. requires FIVE years of being morbidly obese?

Do you get along with your familly doc? If so, maybe you could ask him/her to write up a letter stating that since X date until present you have been overweiht or weighed X amount of pounds at X height.

[Mom2Axel 0]

So other than gall bladder surgery and follow up, the ONLY times you were at a Dr was for pregnancy? Wow, you must be healthy.

Which insurance co. requires FIVE years of being morbidly obese?

Do you get along with your familly doc? If so, maybe you could ask him/her to write up a letter stating that since X date until present you have been overweiht or weighed X amount of pounds at X height.

I have been fairly lucky with my health. I suffer from back aches, and acid reflux, but I have always been able to keep it under control. So I have never actually ben diagnosed acid reflux. I think my age has alot to do with it. I would have been 14 when my gallbladder was removed. I was 20 when I got pregnant. I have decided to try the lap band now while I am 22 and still in good health, instead of waiting another 10 - 20 years and be in my Mother's boat and have high blood pressure, pulmonary embolism, type 2 diabetes, and my father high cholestrol.

Oh and the fact that right after high school I was no longer covered under my parents health insurance and I didn't aquire my own health insurance until jan 2007. I couldn't afford healthcare from 2004 to 2007, so thats why I didn't go to the doctor.

I am going to have to wait until my consult to see what kind of documentation my insurance company is going to require, from what I read, every case is different.

[faithmd 14]

Absolutely do NOT wait until your consult!!!!!!

You can take charge of this yourself, and then you will know fro sure what you need. Grab your insurance card and pick up the phone and call your insurance company yourself. Ask if based on YOUR policy number if you are covered for adjustable gastric banding. Ask what the requirements are and then have a copy of those requirements snail mailed and emailed to you. That way you know what you need to start doing NOW.

You also need to ask WHO they will pay for you to go see. Ask for a list. Many insurances will only pay for you to go to a certain group of surgeons and I'd hate for you to find a surgeon's office you like and then find out they are NOT covered by your insurance. Please call today and find out for sure.

If you are required to have six months of visits and diet history, then you can start making those appointments now, rather than lose a month or more waiting for your consult. And also ask what kind of documentation will suffice for the diet history, a few insurance companies will take letters from your doc or records from GOING to weight watchers or Jenny Craig, LA Weight loss, etc. But often they require MONTHLY MD visit NOTES discussing your attempts at weight loss and MONTHLY weights. Find out these specifics, too.

Trust me, it will serve you well to call your insurance today.

[faithmd 14]

Which insurance co. requires FIVE years of being morbidly obese?

Do you get along with your familly doc? If so, maybe you could ask him/her to write up a letter stating that since X date until present you have been overweiht or weighed X amount of pounds at X height.

Mine did.

Five years of morbid obesity or 100+ lbs overweight. And in my insurance's case they did not accept any letters from the doc, only copes of office notes, so for five years I had to have my yearly exam note with my weight on it sent in. But often if you could show that five years ago say you were 110lbs overweight and then three years ago you were still 130lbs overweight and now this year you are 105 lbs overweight, that's likely to be good enough.

[Mom2Axel 0]

I talked with the my insurance company yesterday, they cover the surgery if:

you have documentation of morbid obesity for 5 years (i have been obese my whole life, I just don't know if I can find sufficent documentation)

over 21

In network hospital (when I schedualed the consult they said they are under contract with UHC, its all in-network)

She didn't mention anything about the supervised diets. And I do have a bmi of 50, so I think that will help my case.

[faithmd 14]

That absolutely will help your case, but I'd call back and ask for then to mail a copy of their requirements to you. Trust me, you want it in hard copy. With insurance companies you can never trust 'em until the payment is approved. I'd also ask about specific diet requirements, it is rare indeed that an insurance company would cover a surgery without you having "proven" to them you have tried diets and exercise and they didn't work. Usually that means three months to a year of a "program" that is supervised. I'd double check just to be sure, it can't hurt.

[faithmd 14]

The notes for your gallbladder surgery should have your weight on them, and hoepfully your ER note will, too. They sometimes ask your weight even if they don't weigh you. Then you can get the notes since you got pregnant that should have weights on them. That would hopefully suffice for a longer than five year history of MO.

Contact each of these institutions where you had treatment and ask how you get a copy of the notes. That way you have them. Also ask about costs associated with obtaining the records. Some places charge you to get copies, but if you have them sent straight to another doc, it's free.

[bakerdvd 0]

I talked with the my insurance company yesterday, they cover the surgery if you have documentation of morbid obesity for 5 years

[bakerdvd 0]

insurance companies you can never trust 'em until the payment is approved.

[isaviolinist 11]

I basically just got all of my records from the past 5 years from my primary doctor. He also wrote me a referral for a bariatric consult and that was it. I didn't need to prove that I had tried diets or anything like that. I sent in my history from my PCP, did all my pre-op testing, and was approved probably a day or 2 after that (and insurance covered the whole thing). I have BCBS and my hospital is an approved center of excellence by BCBS, so that may have helped (my surgeon seemed to imply that they work most closely with BCBS). I do believe some patients that have Aetna or some other insurance like that had to do a supervised diet. But it seemed specific for that insurance only. Good luck!

[bakerdvd 0]

You also need to ask WHO they will pay for you to go see. Ask for a list. Many insurances will only pay for you to go to a certain group of surgeons

[bakerdvd 0]

you have never trasted insurance companies for em until the payment is approved.