What do you think....

I went to the consultation last night, and saw Dr. Gupta, had my Psych. thing today and he "passed me" I guess you could say.  So here is my question.... My insurance says I DO NOT need a 5 year weight history.  Gupta's office says I do.  Now my insurance isn't just "united Health Care" it is through Oxford Health so please keep that in mind.  My insurance has said I only need a BMI of 40 or higher and no medical records, no supervised weightloss thing, nothing. YES I have been overweight for 5 years, BUT I have not had a BMI of 40 or higher for 5 years.  I have always weighed over 200 pounds but not enough to have a BMI of 40.  I am afraid if they submit the 5 year history (when my insurance says they do not need it) that I would get denied. There was a point where I only weighed 205 but that was after I was on adipex and was in the process of gaining all of it back that I lost with the adipex. So I am kind of nervous that it won't happen.  Not to mention I have no weight for 2004 because I was pregnant from Jan. through Sept. and didn't go back to the doctor until 2005.  I am sure I am reading into this more then I should be, but I really don't want to be disappointed! What do you think?

If you haven't already, I would call your insurance company and verify that you do not have to submit 5 years of weights--get the name and phone number of the person you speak to (document, document, document everything from the insurance!).  Then, I would call Dr. Gupta's office and explain that your insurance does not require the 5 year weight loss and that you do not want to submit it.  If it is Dr. Gupta's office policy that says you have to submit the documentation and not just Dr. Gupta's office assuming that all insurance companies require it, then you might have to submit it anyways (just like my insurance didn't require me to have a psych eval, but my surgeon did so I had to have a psych eval). About the year that you don't have a weight for--don't worry.  I only had two weights--one more than five years ago and one four years ago.  Basically my insurance just wanted to make sure that I had been fat for awhile so the two weights I had showed that! Good luck and keep your head up--insurance stuff is tough!

There was a period of time during my 5 years prior to surgery when I lost weight and got under 200 pounds.  But I soon gained it all back.  It did not disqualify me from surgery, rather it helped prove the point that I couldn't keep the weight off for any significant length of time, thus creating a "necessity" for the surgery.

My insurance didn't require 5 years or anything they just required it be medically necessary. Dr. Cacucci (same office) asked for 5 years but I could only come up with 3.5 because the doctors office I went to in Louisville closed down and I couldn't locate my records and so I just explained that and they said that was fine and submitted and I got approved.

That is completely not true.  All insurance companies are different and mine DOES NOT require it and neither do a few others that they talked about at the meeting.  Don't know where they got that its an "Indiana Law"  That would be some law!

The Indiana law actually says that an insurance company cannot impose a pre-operative required "wait" or "program" longer than 6 months in duration.   M-Plan used to require 18 months of supervised diet/exercise/counseling/etc.  The state intervened and said that programs like that couldn't be that long. 

I see, well I know for a fact my insurance does not require any kind of doctor supervised weightloss program and neither do a few others.  Maybe we aren't talking about the samething.  But that wasn't really my question. My question was about the weight history that I KNOW my insurance does not require. Thanks!

Leanne, While your insurance company may not require the 5 year history, Dr. Gupta may. Many/most surgeons may...especially when your BMI is relatively low (which...if you have co-morbidities, there isn't near as much emphasis on the BMI). The first thing I would do though is get a copy of your insurance weight loss surgery policy. Just give them a call and ask them to send it to you. Then make a copy of it and give it to Dr. Gupta's office (I always keep a copy of stuff like that for my records). Also give them whatever weight records you do have. My family doctor's office that I had went to in Clinton for 16 years couldn't locate my file at all so what I had given Dr. Gupta & Anthem was a statement from my workplace's Emplyee Health Servises, on their letterhead, written by one of their nurses, with my weights since I'd been in their employ. Over the course of ~15 years, there were maybe 6-7 weights down since we don't have physicals every years. Obviously, some years, there were no weights down. That wasn't an issue for Dr. Gupta's office or the insurance. It was sufficient to show that I didn't just plump up over-night. So give Dr. Gupta's office the weights you do have and don't worry about 2004's. Sherri

I did not have to have a 6 month supervised diet or 5 years of medical records for my insurance to approve me.  Now, Dr. Gupta's office wanted the 5 years of records in case the insurance asked for them.  They did not submit my records to the insurance company.  So if your insurance comp. doesnt require them I imagine they will not submit them to the insurance.  They just keep them in your file.