Question:
Anyone get approval without being 100 lbs over for 5 years?
I have a BMI of 40 and am over 100lbs my ideal body weight for about 2 years. I have several comorbidities: hypertension,high glucose, cholesterol,triglycerides, stress incontinence,shortness of breath, chronic pain of weightbearing joints,depression and anxiety, edema, heartburn...Will this be enough to have them make an exception to the 5 yr. rule? — janie K. (posted on August 7, 2001)
August 7, 2001
What exactly does your insurance say they want?
Mine only wanted me to prove that I had been on a "medical supervised
diet" for 1 year - but not necessarily morbidly obese - I only had to
be morbidly obese to be considered at the time of surgery - it is all based
on how your policy is worded.
— Sharon Jones
August 7, 2001
Is the "5 year rule" in your insurance policy? I heard of this
rule from a few people on this site, but I believe it is specific to a
particular insurance company (which one I don't know). It is not a general
rule. I had a BMI over 40, I did not have to have been on a medically
supervised diet or have to meet the 5 year rule. I had my surgery 1.5
years ago and only recently have heard of this.
— Gina E.
August 8, 2001
I HAVE CIGNA AND THE ONE MAJOR RULE WAS A BMI OF 40 FOR NO LESS THEN 5
YEARS, BUT IF YOU HAVE COMORBIDS AND 100LBS OVER THEY SHOULD APPROVE
SURGERY FOR YOU. THERE ARE WAYS AROUND THIS HANG IN THERE. JUST DON'T
GIVE UP IT TOOK ME ALMOST 1 YEAR TO GET TO SURGERY, BUT I MADE IT SURGERY
SET FOR OCT.
— PAMELA T.
August 16, 2001
Hi..! My Ins. Co. is Medical Mutual of Ohio (Super Med Plus). Their
requirement was "100 lbs overweight for period of 5 years, with PCP
documentation for that period". When I went to my consultation, I was
only 89 lbs overweight (I am, after all, only 5 feet tall - 10 pounds extra
shows BAD on me! lol), and the "documentation" I turned in from
my Dr. was a just sheet of paper from one of those notepads that the drug
reps leave for the staff, with the years and maximum weight recorded. It
was stamped and signed by the office staff. HOWEVER, my co-morbidities
include arthritis, edema, joint pain, fatigue, already had to have gall
bladder removed, already had to have bladder suspension to correct stress
incontinence... etc. My surgery was APPROVED with the first fax.. it took
about 5 weeks for me to get my copy..!! I'm waiting on a surgery date
SOON!
Sooooo...obviously my co-morbidites outweighed (no pun intended) my
"not being fat enough" (what a JOKE that is..!!). Keep the
faith.. if this surgery was meant for you... it will HAPPEN..! God
bless..and good luck!!
— Diane E.
August 26, 2002
i HAVE MEDICAL MUTUAL AND THEY HAVE THE 5 YEAR 100LBS OVER IDEAL BODY
WEIGHT & A BMI OF 40. IAM 100LBS OVER WEIGHT. I HAVE BEEN 90-100LBS
OVERWEIGHT FOR THE PAST 5 YEARS. MY BMI HAS RANGED BETWEEN 32-40. I HAVE
SEVERAL COMORBIDITIES. I WAS DENIED THE FIRST TIME. I AM NOW IN THE
PROCESS OF MY FIRST APPEAL. I HOPE THEY WILL APPROVE THE SURGERY THIS
TIME. I WILL FIGHT THEM IF THEY DON'T UNTILL THEY DO BECAUSE I CAN'T LIVE
LIKE THIS. JUST FIGHT. IT'S YOUR LIFE. SOMETIMES THEY NEED REMINDED OF
THIS, I THINK.
— SHERRIE S.
September 26, 2002
My ins compay policy states the same thing. I have been 100 pounds
overweight for 3 years, but overweight since the 5th grade. I was approved
this morning. Unless they specifically ask for your weight charts for the
past 5 years, they have no way of knowing that. I had to give 2 years of
medical notes.
— Cynthia A.
September 26, 2002
I was not 100 pounds overweight for long- but I had gained 70 pounds in 3
years and the MD agreed that if I continued at that rate- I was headed for
trouble- though I had always been "heavy" typically I was 50-70
pounds over at any given time- Often losing it on one fad diet or another-
— ~~Stacie~~
September 26, 2002
Hi, my insurance company(according to the web site) said I had to be 100
lbs overweight for the 5 years. I wasn't and was still approved just in
August. And, my BMI was barely 40, so sometimes they will approve you even
if you think it is unlikely(as I did!lol).
— Helenjean P.
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