Question:
About that STUPID 5 year obesity clause
Hey guys, sorry to keep bugging you all about this. This 5 year obesity deal that Blue Cross/Blue Shield requires, what does that entail? Can I submit paperwork showing that I visited the dr each year for 5 years and show I was/am a fatty? Or what do they need? This is the exact wording from their website: At least a five-year history of Morbid Obesity supported by medical record documentation. — 1fatgurl (posted on October 19, 2006)
October 19, 2006
Hi, I do insurance billing for a living and what BC/BS is saying is that
you must have a 5 year history of being MO. You probably haven't been with
them for the last five years. So all you should have to do is submit Dr's
records to show that you have been MO for the last 5 years. Your PCP
should have this in his records so you should be able to ask them for
copies of your weight off your record for the past five years. They may
charge you a few bucks to do it, but most will. Good Luck.
— Sheryl H.
October 19, 2006
I was approved throught Aetna and they required the same thing. I went to
all of the doctors I had been to for the past 6 years (just to be on the
safe side) and got copies of my charts and they all had my weight on them
and also stated that I was MO. The insurance company got copies of all of
that plus I put the data in an excel graph to show them I have been
overweight forever and it was just getting worse.
— *Malena* M.
October 19, 2006
Nancy, it is not just BCBS, my sister had the same problem with United
Health Care (UHC), her policy from where she retired from. It is not the
insurance company per say, it is how the policy is written. The reason I
say this is because my same sister was recently employed by a company that
also has UHC and she had her RNY in Sept. She did not have to be MO for 5
years. She did not get denied because of not being MO for 5 years. This UHC
policy said that it had to be medically necessary for her to have surgery
even though she was only MO for 2 years. Chris
— ChristineB
October 19, 2006
I have BC/BS and besides being medically necessary, the 5 year history of
being obese was a requirement. That was not a problem but rather than send
them copies of my medical records I ask my doctor to list my top weights
for 5 years on letterhead and that was acceptable. Good Luck.
— god4me2
October 20, 2006
I have BCBS and they accepted documentations of all my weigh-ins when
visiting the doctors for general care. My doctor did not charge me for this
benefit. My approval thru BCBS was quick. They sent me a check-off list via
email of all its requirements for WLS. Benita Lewis
— NEETAJEAN
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