HELP with Insurance wording 5 years...

[pephlin 0]

I recently went to True Results and was told that my insurance would cover me 90% if my BMI was 40+. But, my insurance had the following conditions. A weight history for 5 years. Do they mean a BMI of 40+ for 5 years? The person from True Results told me that it had to be 40+ for 5 years. or 35-39 with two co morbid conditions for the past 5 years. Does this sound right? I have a BMI of 40 but only for the last 2 years and I was in the 35-39 range for the last 5 but I have no co morbid conditions.

[Lighterload 0]

Hey Pephlin,

Sounds to me like you have the same insurance that I have. :biggrin: I had the same requirements needed for approval for 100% coverage, for the LapBand. It took me 7 months, and a lot of determination and foot work to get it all done but it is so worth it. I was required to show that I had a BMI of 40 or more for the past 5 years, that I was on a physician monitored diet within the past 24 months and that I was capable of losing at least 10% of my body weight. I also have co-morbidities of hypertension and arthritis. :beer_yum: I needed a formal letter of Medical necessity from a doctor other than a Bariatric doctor, complete cardiac and pulmonary work-up, complete psych evaluation, Ct scan of the abdomen, bloodwork and then you sit and wait until the insurance decides if they will approve you on the info presented. Its tough, but worth it. I was denied twice even after presenting all the required paperwork, for silly things like a physician did not sign his progress note with his full name but used his first initial and last name. It was very frustrating process but being who I am, I would have taken it to my Senator before I would have given up and let the insurance company win, and I think they knew that. Good Luck with your journey, hang tough and don't give up- I wish you the best- Lighterload

[Chris61 0]

I aslo had to show five years of data and I can forward you a letter that my wife and I used to get approved. Also you can get it from all your doctors and put it into one letter to the lapband doctor. It took me about 6 months to get it all togehter because I had records all over the place and not in one place. Also I had some medical records from work that I also used and was approved in no time. If you have any more questions just ask.

Chris

[BethL 0]

Chris,

Can you send me the letter for approval?

[Chris61 0]

If you forward me your e-mail I will send it out to you.

Chris

[ahb08 0]

I recently went to True Results and was told that my insurance would cover me 90% if my BMI was 40+. But, my insurance had the following conditions. A weight history for 5 years. Do they mean a BMI of 40+ for 5 years? The person from True Results told me that it had to be 40+ for 5 years. or 35-39 with two co morbid conditions for the past 5 years. Does this sound right? I have a BMI of 40 but only for the last 2 years and I was in the 35-39 range for the last 5 but I have no co morbid conditions. :scared2:

hello, im also going through true results.......but who is ur insurance company?

[mandyclemm 0]

I am in the same situation could i please have a copy to

[mandyclemm 0]

mandyclemmons@comcast.net thank you

[Chris61 0]

Keep in mind that there are many things that can be co -issues that we might not think of such as back, shoulder problems, Walking problems,hypertsion, and a hole host of other things. Just need to sit down and make a list of issues/problems you are having and go and talk with your doctor about these and have him write a letter. Every insurance company is differant in how they look at things. I would just make a list and have the doctor send them in and see what they have to say, Also keep inmind you can use all your doctors that you go to for tracking weight by the year. It does not have to be just one. Good luck and if you have any questions just ask.

Chris