Question:
Was your insurance companies medical necessity 100 lbs /no co-morbidities?

Help! I have a BMI of 49, with lots of health problems. My federal ins co will not approve me with out a specifid co-morbidity. Please respond with your info if your ins co approved you by following the fed guidelines. over 40 BMI. Thank you, Maurine    — Maurine S. (posted on December 28, 2000)

December 28, 2000
Hi Maurine! Here is the criteria for Kaiser Souther California: Criteria for Referral: To be referred for bariatric surgery, candidates must have a BMI: - equal to or under 35 with one or more LIFE-THREATENING comorbid conditions - OR - - 40 - 50 with at LEAST two SERIOUS comorbid conditions -OR - - over 50 with or without comorbid conditions Comorbid conditions are defined as ANY of the following (NOTE: Conditions must be life-threatening or serious as indicated above): -Obstructive sleep apnea documented sleep study -Degenerative Joint disease with abnormal x-rays and a recommendation from an orthopedist for joint replacement -Symptomatic ventral hernia -Congestive Heart failure and cardiomyopathy -Diabetes mellitus -Hypertension -Hyperlipidemia -Extremity edema with ulceration -End stage renal disease with difficulty dialyzing -Amenorrhea related to obesity -Incontinence related to obesity -Low back pain if patient is significantly disabled, has x-ray changes in the spine and an orthopedic recommendation for weight loss and/or back surgery Additional KAISER Patient Requirements for bariatric Surgery: -Must have been under the care of a SCPMG physician for at least one year -Details of attempts of weight loss, social aspects of patient's obesity and eating patterns should be documented -Must have mental health consultation to rule out serious mental illness -Must be evaluated by a "bariatric" surgeon to discuss the general aspects of gastric bypass surgery
   — careywatkins

December 28, 2000
I had CIGNA PPO, and my bmi was 43. I was approved by CIGNA with no documentation of co-morbidities, and no documented diets. I reported my physical problems, like high cholesterol, pain in my feet and back, but I did not have any official documentation, and they didn't ask for it. I think as long as your BMI is above 40, you meet the medically accepted guidelines for surgery, but that doesn't mean the insurance company can't make up their own un-reasonable guidelines. Good Luck!
   — Lynn K.