Insurance Quandry

I live in TX and have United Healthcare.  My employer's policy states that surgical treatment of morbid obesity is covered under the following conditions:  BMI of 40 or greater, 5 year weight history of morbid obesity, and at least age 21.  There are no other conditions, no diets, psych eval or anything.   I have a BMI of 36 with type II diabetes and hypertension.  I have a five year history of being obese (between 33 and 36 BMI).  Under these cir****tances, does anyone think I have any chance of being approved for surgery? Thanks!

It is worth a try.  I have UHC in VA, but I have a BMI over 40 and no co-morbidities that I am taking medicine for.  I have the beginnings of High Blood Pressure, Sleep Apnea, joint pain, and lower back pain.  My doctors office experience with UHC is that you need two co-morbidities with a BMI between 35-39.   So, with that I would say give it a try.  I did have to have psych evaluation before my paperwork was submitted to the insurance company.  I was approved in four days and my surgery is in March.  I also submitted a 5 year weight history from my PCP and OB/GYN.  There was one pregnancy included with that information, but I don't know if that hel*****t.  I was over weight during the pregnancy also.  I had two years with my BMI under 40, but still above 35.  I had three years of a BMI over 40.  No 6 month diet. I hope this information helps and let me know if you have any more questions.

I can shed some insight on this one.... I have recently had a denial for a patient because her bmi was under 40, even though she had the 2 co-morbis conditions. Her husband's employer specifically had it in their contract with UHC that the bmi has to be above 40 for the last 5 years to qualify. Typically UHC is the 35/2 CM's or above 40 bmi rule, but not in this particular case. You can fight it, but honestly you do not have a good chance if your policy is like the one I just spoke about, especially since you were never above a bmi of 40 in the 5 years. Good luck! Bonnie

Thanks for the insight!  I actually have had the problem resolved, though, because I was able to get my HR department involved.  Last year the surgery would have been covered with 35-40 BMI, only one co-morbidity, so I thought it was bizarre that the coverage would change this year.  Sure enough, after a lot of back and forth with HR, they have restored the previous policy and BMI of 35+ will now be covered!  So happy I could spit!