I would say, it depends on your insurance. I go through a different company and there's never a gaurntee but no harm in asking. Go to do your Insurance person at work. Get the name and number of the rep for your insurance. If they say no after you apply, you can always apeal...and I fought for 3 years to get mine paid for...I'm glad I did.
Do you have a copy of your policy? First thing is to make sure your policy covers WLS, then, if they do, find out specifically which procedures it covers. They can't deny you based solely on that you are part-time or that you may be on a short-term policy. If you meet their requirements and jump through their hoops (some require a 6-month supervised diet, psych evaluation, etc.), then you should be covered.
Thanks ladies...I keep reading about the 6 month supervise diet...this brings up a question for me.
My weight has been going up for the past 5-6 years.I went from about 200 to 265 in that time. I have seen my PCP on a regular/yearly basis. I have also joine WW, Nutrisystem, LA Weight Loss, and had a trainer during those 5 years. Is that what they are looking for? or do they want my PCP do actually monitor me?
I know you all dont have the "answers"...I just want to get some perspective.
your best bet: have a nice long chat with your doc - and explain what you've been doing over the past years. the doc should be able to help you document that you've met the requirements. after all, over these years, this is the person who's seen you gain, and maybe discussed it with you.
when i had surgery - and this was before a lot of the requirements were tightened - all i had to do was present a diet history. OTOH, since my BMI was over 60, and i was very ill, i doubt that any insurer - even today - would have denied me.
For the 6-month thing, it all depends on your policy. Some require that you check in monthly with a nutritionist or doctor for 6 months, while others will accept 6 months worth of records from a program such as WW where you show regular attendance/weigh-ins. For mine, I had to see my PCP every month for 6 months, and my doc had to record all my vitals (temp, blood pressure, weight, etc.) plus had to specify that the appointment was ONLY for weight loss and nothing else. I had one appointment where the reason for the visit was noted as follow up for diabetes and weight loss, and they made me do another month because that one mentioned diabetes instead of only weight loss. I would try to find out directly from your insurance company.
Last edited by jillybean720; 10-06-2009 at 11:08 AM.
aaneri, if your ticker is accurate, you're 5'10 and 248. That puts you at a 35.6 BMI. In the US, this will not qualify you for WLS unless you also have weight-related comorbidities (high cholesterol, type 2 diabetes, sleep apnea, high blood pressure, etc.). So that's another thing to check with your insurance on, as some require you to have at least TWO comorbidities if you are between 35-39.9 BMI.
question about insurance
