Question:
Are insurance companies required to go by NIH guidelines?

My insurance company today said they were requesting more info from my endocrinologist because I do not meet their requirements of a 40>BMI and comorbidities. I meet the NIH guidelines of 35>BMI and comorbidities. Can insurance companies use something other the NIH guidelines for medical necessity for WLS?    — Tremia A. (posted on March 27, 2003)

March 27, 2003
if insurance companies were required to adhere to the published NIH guidelines, few of us would have trouble getting our insurers to pay for WLS. unfortunately, insurance companies can have very different requirements, or simply refuse to pay for WLS at all.
   — Kasey

March 27, 2003
National Institutes of Health is a research agency, not a regulatory one. Yes, insurance companies can and do have guidelines that differ from NIH. Some have 35> with comorbids or 40> w/o
   — Sandi L.