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Im 5 ft 6 and weigh 260. I think my bmi is around 40-42 right now. I have pcos, a testosterone dificiency, high cholesterol, and hypothyroidism.
My concern is that I was able to drop over 100 pounds in 2012, I went from 317 pounds to 195 in a little over a year with a strict diet and exercise routine but then my hormone issues kicked in and I've ballooned up over the last 2 years. I still work out and eat healthy. I'm on so many meds it's ridiculous. The weight isn't budging.
Will the the fact that I lost weight then gained it back hurt me?
not necessarily. It depends on exactly what your insurance requirement specifies. Some want proof of loss with no gain and some only want proof that you tried and weren't successful. Losing it and not keeping it off is sort of a gray area. Have you read your policy for yourself to see what it says?
PCOS may be the only comorbidities you have but your BMI should qualify you.
on 1/24/16 2:23 pm
Im 5 ft 6 and weigh 260. I think my bmi is around 40-42 right now. I have pcos, a testosterone dificiency, high cholesterol, and hypothyroidism.
My concern is that I was able to drop over 100 pounds in 2012, I went from 317 pounds to 195 in a little over a year with a strict diet and exercise routine but then my hormone issues kicked in and I've ballooned up over the last 2 years. I still work out and eat healthy. I'm on so many meds it's ridiculous. The weight isn't budging.
Will the the fact that I lost weight then gained it back hurt me?
Just wondering how many of you have had your surgery approved through MVP insurance. They are based in New York. I live in Florida and have the EPO plan. Are they more likely to deny or approve WLS?
they told me I need to have proof that my weight has been an issue for 2 years, documented proof that I've tried a medically monitored diet plan for at least 6 months, and have a BMI of 40+ (35+ with weight related health issue).
I've had weight issues my whole life. Not sure where to start with documenting this.
for documentation,you would need doctors visits,including a weight,on those visits for 2 years. You also need proof of 6 months of medically ,doctor supervised weight loss.
if you have seen a doctor recently,or in the past,you should know if you have diabetes,sleep apnea,high blood pressure etc that are co morbidities. What is your current BMI?
on 1/23/16 2:08 pm
Just wondering how many of you have had your surgery approved through MVP insurance. They are based in New York. I live in Florida and have the EPO plan. Are they more likely to deny or approve WLS?
they told me I need to have proof that my weight has been an issue for 2 years, documented proof that I've tried a medically monitored diet plan for at least 6 months, and have a BMI of 40+ (35+ with weight related health issue).
I've had weight issues my whole life. Not sure where to start with documenting this.
That is what I figured. I was mostly just wondering if there would actually be a possibility of finding another insurance or if I am most likely going to be marked as "uninsurable" now as there are records of morbid obesity and my wanting to have bariatric surgery.
no,it is now illegal for insurance companies to deny coverage to ppl for pre existing conditions.
That is what I figured. I was mostly just wondering if there would actually be a possibility of finding another insurance or if I am most likely going to be marked as "uninsurable" now as there are records of morbid obesity and my wanting to have bariatric surgery.
I desperately need this surgery. I have Blue Cross/Blue Shield in Montana. I was just told that BC/BS will not cover any medical anything to treat obesity...that they would cover appointments at the metabolic center if I had a comorbidity (I do not, I am just obese.), but they won't cover the surgery at all, for any reason.
Is there any hope? Doctors agree that I need this surgery but insurance doesn't care. Would I be able to get on another insurance now that I have started the process and there are records of my obesity and need for surgery? I mean, would other insurances pretty much consider me "uninsurable"? We went through a process to find an insurance in the first place because of my weight.
btw we pay for our insurance ourselves, it is not through work.
Thanks in advance for any help you can give me!
no,if it is excluded on your policy,it. Means that you are not paying for bariatric coverage in your premiums.
All you can do is get new insurance that covers it or self pay. Sorry to bear bad news.
I desperately need this surgery. I have Blue Cross/Blue Shield in Montana. I was just told that BC/BS will not cover any medical anything to treat obesity...that they would cover appointments at the metabolic center if I had a comorbidity (I do not, I am just obese.), but they won't cover the surgery at all, for any reason.
Is there any hope? Doctors agree that I need this surgery but insurance doesn't care. Would I be able to get on another insurance now that I have started the process and there are records of my obesity and need for surgery? I mean, would other insurances pretty much consider me "uninsurable"? We went through a process to find an insurance in the first place because of my weight.
btw we pay for our insurance ourselves, it is not through work.
Thanks in advance for any help you can give me!
I work for Amerigroup and I process a lot of claims for WLS. From everything I have seen it seems that you have to do 6 months nutrition counseling and all the other standard tests. It also depends on what state you live in because each state has it own plans and rules.
I thought they changed it to 3 months? But thats just what they told me over the phone. I'm hoping to switch to Health Plan of Nevada since they are easier to deal with.
I work for Amerigroup and I process a lot of claims for WLS. From everything I have seen it seems that you have to do 6 months nutrition counseling and all the other standard tests. It also depends on what state you live in because each state has it own plans and rules.
Hockeymom87 · 0 replies · 809 views
