Question:
Is a BMI of 40+ automatically considered MO or do Ins co have final say?

My policy states "surgical correction or treatment of obesity is exluded except when necessitated by a specifically identifiable medical condition and the condition is Morbid Obesity." From this site I've seen that MO is a BMI of 40 or more or 100+ lbs overweight. But I am sure that I have also seen someone say that their insurance company's definition of MO was with a BMI of 50. Do they have the right to modify the medical definition and not accept you for the WLS even if you are over BMI of 40? Thanks in advance for the input!    — ChristiMNB (posted on February 20, 2001)

February 20, 2001
I suggest you go to the Gallery Page on obesityhelp.com and check your BMI -- you'll need to put in your weight and height. It clearly will show you if you fall into the Morbidly Obese category or not. I don't know if there are different standards for determining this in the industry. But, you could use a printout of your results to build your case. Best wishes.
   — Cindy H.

February 20, 2001
When I first applied to have this surgery, I got a packet of information at the seminar. In the packet was a medical history packet to fill out that included a full page just for diet history. It also included a page that listed 4 things that will completely stop your processing. Number one of the list was not having at least FIVE years of diet history. Personally, I tend to forget things that aren't pleasant memories, i.e., failed diets, and I'm also pretty bad with dates in general. So I just included a few of the diets I could think of off the top of my head. The patient co ordinator said that I had to try and do better on the diet history to avoid problems. I said even thought I have a BMI over 40 and at least 3 co mobidities? She said a better history would be better. So I would say that different insurances can require more than just a BMI of over 40. Whether or not it's legal to increase the requirement to 50 I'm not sure. I would say apply for the surgery and if you get denied then try an appeal. If you still get denied then contact an atty. Best of luck. Sherry
   — sherry hedgecock

August 2, 2001
No they do not. Your BMI is based on feedback and testing from medical professionals, your insurance company is not one of them. If they are telling you this then maybe it is time to consult an attourney or petetion the matter further asking them to define why they do not believe this to be the case.
   — Shannon J.

Click Here to Return