Oxford freedom plan, ny

 Just starting this journey. Has anyone dealt with Oxford freedom plan? I have a bmi of 36 with pcos, prediabeties, mild sleep apnea. What has your insurance process with Oxford been like?

Hey there.  Best of luck to you.  It may be difficult.  I just went through the process with Oxford.  Be prepared for a fight.  They will do everything they can to deny you.  They are pretty specific with what they consider a co-morbidity, and I am pretty sure they will deny you.  Where is your policy written?  Your appeal options will vary by state where the policy was issued as well as if you are fully-insured vs. self funded..

If your BMI is less than 40, you have to have one of the following:

• • Cardiovascular disease (e.g., stroke, myocardial infarction, stable or unstable angina pectoris, hypertension or coronary artery bypass)
  • Life-threatening cardiopulmonary problems (e.g., severe sleep apnea, Pickwickian syndrome, obesity-related cardiomyopathy)
  • Type 2 diabetes

   

  AND

   

• Patient selection criteria for bariatric surgery include (NHLBI, 1998):
  • Active participation in an integrated clinical program that involves guidance on diet, physical activity and behavioral and social support prior to and after the surgery.
  • Psychological evaluation to rule out major mental health disorders which would contraindicate surgery and determine patient compliance with post-operative follow-up care and dietary guidelines.
  • Documentation of a motivated attempt of weight loss through a structured diet program, prior to bariatric surgery, whi*****ludes physician or other health care provider notes and/or diet or weight loss logs from a structured weight loss program for a minimum of 6 months.