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Hello All,
I have Aetna and I am nervous about one part of the clinical bulletin...The 24 months documented weights. I have been obese my entire adult life and in 2009 my doctor advised me to lose weight. Well, I did. But an injury in 2011, caused me to be unable to workout for a while...you know the rest...Here I am today, I gained it all back plus 13 pounds! In 2011, my bmi was below 40 (37.4 to be exact). I have no comorbidities that I know of (sleep study is next week). I am currently at BMI of 43 or so. Anyone, have this issue? I am gathering weights back to 2006 to show I didn't just become obese lately. Oddly, one of the requirements is that you actually had to try to lose weight and be unsuccessful. *Sigh* This is so frustrating! Any advice is welcome!!!
Preop: -10; Mo 1: -21 Mo 2: -11 Mo 3: -10 Mo 4: -15 Mo 5: -10 (Onederland 2/19/14!!!) Mo 6: -11 Mo 7: -8 Mo 8 : -9 (100 pounds lost 5/13/14!!!) Month 9: -5 Month 10: -5 (Goal 7/14/14) CW:157.8 (-2.2# BELOW GOAL)
With our plan you don't need the 5 year weight history, but we do need the 6 month supervised diet history. We were even told they didn't need to be consecutive.
I guess in November I will find out (my 6 months is up then)m whether I get approved. I have my pysch eval soon, and I am going to a doctor about the sleep study. Hopefully with the questions that are asked, I won't qualify, and don't need to worry about it.
Then go to my Nut a few more times.
Hey everyone! I'm starting the journey to be approved by my insurance (Healthy U Medicaid) for gastric bypass.
I found the requirements online through the state Medicaid website and I'm just looking for a little clarification. I know some insurance require documented diet plan for 6 months, but this is what mine states:
The medical record must document, with a supervised weight reduction program, a body weight loss of at least 10% within the six months prior to the request for bariatric surgery I am 5'10 and weigh 311, does this mean I have to lose 30lbs before I can be approved? Do I have to diet for a certain amount of time or is it just as soon as I lose the weight within the six months prior. I also HAVE to have a bmi of at least 40 to qualify. If I lose 30lbs, I will be right at the edge and I'm afraid I will not qualify.Any info is appreciated!
Thanks so much
Thanks
) 
Have you been to a doctor at all prior to five years? If so, make sure those records get sent to the place you want to have surgery. They should be able to help you do this. Have you attended a weight loss surgery seminar with the center? If not look into one. They are free, and will answer questions and help you get everything you need to do to get what you need to get insurance approval.
Good luck!
Good luck!!
Laurie
Sleeved 6/12/13 - 100 pounds lost to get to goal!
I had United for awhile and what one insurance coordinator told me is UHC almost always demands the six month supervised diet (you will have a nurse calling you to check in), and 5 years of medical records. The 5 years of weight records can be from anywhere; your gynecologist's annual report when you get your exam is enough, and you can even use ER visits, regular doctor visits, and combinations of the above. Really if it was recorded anywhere you can use it.
I hope that helps!
Hockeymom87 · 0 replies · 727 views
