Will insurance cover if you have already lost weight on your own?
I have the same plan. My initial submission was denied, as was my first appeal.
I have medical records showing my BMI over 40 since at least 2006 and I'm trying to get them from even further back if possible. Starting in 2008, I began working with my doc to lose weight - twice. Like you, I did well, but it dropped me below 40. When I fell off the wagon the first time, I went back above 40. I later tried again and went back below 40. I had to switch doctors, and about that time I started pursuing surgery. Presently, I am a few pounds below a BMI of 40, but I'm climbing. A few more milkshakes and I should be there.
My first denial letter said the following: "Covered person must have a minimum BMI of 40; Covered person must have documentation of a diagnosis of morbid obesity for a minimum of 5 years from a physician."
I have to think that as long as you can meet these requirements in your charts, you're good. If, like me, you dropped below 40, you may have a fight on your hands. I presently am gathering all of my records to send to Walter Lindstrom and have him walk through the appeals process. They feel I have a good shot of being approved, particularly if we get to external review.
Good luck!
Sleeved 6/12/13 - 100 pounds lost to get to goal!
I'm not sure. That's something I'm going to have to find out, as well on this journey I am on. I am not sure if they can figure this out on their own e.g. "her weight was x and her height was y; yep, BMI > 40 so she wins", or if they want a diagnosis code. Based on what I have heard, I worry it'll be the latter. I have a specific notation in my chart from 2006 that has "obesity" labeled as a diagnosis, but there was no "morbid" and that was at my highest weight ever, BMI = 42.2.
Makes me wonder when the term "morbid obesity" came into widespread diagnosis, vs just "obesity".
Sleeved 6/12/13 - 100 pounds lost to get to goal!
Batwingsman · 0 replies · 1345 views