BMI has fluctuated over the years

[daco525 0]

I currently have a BMI of 36 with co-morbid conditions: diabetes, hypertension, high cholesterol. I can document my past weight, but several times my BMI has been under 35. I am always dieting. Do you think this will be cause for a denial. I am assuming that the co-morbid conditions qualifies me for having this done medically.

[MacMadame 81]

It depends on your insurance company. Some want a 5 year weight history and some only 2 years and some no weight history. Then some will use any year you didn't qualify as an excuse to deny you while others consider an up and down pattern a sign you need surgery.

However, if they do deny you for that reason, I would think you would have grounds for an appeal as the NIH's guidelines say nothing about being morbidly obese for X number of years just a history of failed dieting.

[oyesican 0]

Hi Daco -

I'm in the same boat. Aetna denied me because I haven't had a consistent BMI over 35 for 2 years. I am appealing through obesitylaw.com. It's a long process but hopefully within another 2 months I'll get an approval.

Good luck to you!

[daco525 0]

Although you BMI wasn't consistently over 35, did you have any co-morbidities. I do have diabetes, hypertension and high cholesterol. I really hope my health will be he deciding factor.

[oyesican 0]

Yes, I have diabetes, hypertension, sleep apnea and joint pain. I really think they just deny automatically hoping we'll give up.I'm going to keep appealing through all of my appeal options until they approve me.

[daco525 0]

Good for you. I will persist also if I am denied. I made my mind up that I am committed to getting this done. Good luck, keep us posted.

[skep 9]

I am kind of in the same boat. I was denied by BCBS of NC. I have a BMI of 39 with severe joint pain. I was denied because I did not have 4 out of 5 year history and no comorbidities. The joint damage did not count. I was under 35 BMI for two years because I was in a weight loss program that included phentermine and lost about 20 pounds which I put on as soon as the program ended. I have contacted Obesitylaw and found that Allergan has a program that will pay for attorney's fees if there is reason to believe that the attorney will be successful in appealing the denial. Unfortunatly, my doctor will NOT cooperate and since it is initiated out the doctors office, I have to pay the attorney fees. My question is, if I change doctors can I start all over with the insurance or do I have to follow through on an appeal? To be honest, I think the insurance specialist at the doctors office does not want a lawyer involved because she did such a lousy job. I have an appointment at duke Weight Loss on christmas eve. Just wondering. also, if I were you, you might want to contact Obesity Law and see if they can be of assistance.

[daco525 0]

How do I go about contacting them. Is there an "800" # or do I just google it. I am located in NJ. Thanks for sharing your story. I have an appt with the nutritionist on Mon. I am still getting things together to submit to my ins. I hope this all goes well. I would like to be prepared in case I do get denied because I would want to appeal it.

[skep 9]

There is a phone number but I just emailed him. It is obesitylaw.com. Walter was very efficient. I got a response to the initial email within a week. He has followed through in a quick and professional manner with me. Too bad that my doctor is not as professional. I guess I don't understand why his office will not cooperate since he is the one who ultimately wins, along with me of course. I'm in North Carolina. I don't think it really matters where you live.

[Band_Groupie 3]

daco- Sounds like you haven't submitted yet...don't do that until you know exactly what your insurance requirements are (my understanding is that you only get a certain no. of appeals and can only re-apply after so many months). You need to start this process by getting a printout of your insurance requirements...this is STEP 1...just call your customer service no. (usually on your card) and ask them to fax you one...or even easier most have them online-just ask them how to access. That way you'll know what your chances are going in.

You can also do a thread on here listing your insurance name and state/specifics (ie. BCBS is totally different coverage in different states/areas...I don't need any weight history other than the 6 mo. diet, others with BCBS need 5 years). Someone may respond that has the same one. Also lots of people found out they had comorbidities they didn't know about just by having their PCP do a full workup/bloodwork. I was borderline hypertension-just over the limit for a few months (one of the 5 "biggies" which I needed at least one of) and after freaking out over this process I was really high at my visit and was put on medication. I wasted a few months not knowing enough about my requirements...get yours in writing.