New Here-- Question about Oxford

kbnnyca · 07-03-2008, 05:35 PM

Hi Everyone,

I'm new to posting but I've been lurking and learning for awhile. I went for my first appointment yesterday and I'm really excited. Everything looks like it will be fine for my insurance and I know Oxford is pretty good about approving people, my only concern is documentation of weight for the last five years. Has anyone else provided this?

They don't need to see a diet or anything like that, I just have to prove five years of obesity. This should be easy, but I'm concerned because between two and three years ago I wasn't going to the doctor regularly at all. If I went five years ago, then maybe a year later, and then a year and a half ago, does that seem sufficient?

thenume · 07-03-2008, 06:20 PM

I would say so..Oxford is really not that picky. As long as you have atleast three years they really don't hound you. I have Oxford and they approve ASAP!

kbnnyca · 07-03-2008, 06:31 PM

That's comforting. I felt really good about it until the drs office started talking about five years. My BMI is 54 though, so surely they can tell that didn't happen overnight.

kristenmh · 07-03-2008, 06:42 PM

who told you that you needed a five year weight history for oxford? i have oxford (and am being banded at NYU) and that's not a requirement.

per the documentation oxford sent me, surgery is automatically approved (with out the need for a medical director review) provided that the patient has a bmi of 40 or above.

kbnnyca · 07-03-2008, 06:54 PM

I hadn't heard anything about that requirement until I went to my dr's office (Dr. Kini at Mount Sinai). He just emailed me and told me I should be okay. When I called Oxford about a month ago they told me I needed a BMI over 40 and a letter from my PCP. Is it possible that they just have a generic checklist that they go over? It says it's oxford-specific but from everything I've read about oxford and what they said on the phone, it seems incorect.

And actually I just noticed that it's for United Health Care as well, so maybe thats for them?