Question:
How do I get
I have been repeatedly denied the gastric bypass by my insurance which is BC/BS of Illinois (suprise, surprise) and in their "new" criteria it states that the insured "must have documented failure of 12 consecutive months of a MD supervised diet" within the last five years. It goes on to explain what a medically supervised diet must consist of. One of those requirements is to have "supervised increase of excersise". Okay so I hope this doesn't sound dumb but short of hiring a personal trainer how do I get someone to "supervise" me while I am working out, lifting weights, doing areobics, swimming, biking, power-walking. Get the picture? In order for me to start going to a gym it has to jive with my work schedule (I'm sure you all go through this). So on top of that it has to jive with someone elses schedule. And who would that person or persons be that would be "acceptable" supervision? Can you tell that the only exercise I have ever done has been in my own home with Richard Simmons on the T.V.? Thanks for any suggestions. — Janice B. (posted on April 22, 2004)
April 21, 2004
My local YWCA, offers a personal chart, to chart your weight, any and all
of workouts you do, minutes on the treadmill, reps, strenghtraining... most
fitness gyms offer these, hopefully this will work for your insurance co.
Good luck
— wizz46
April 21, 2004
I would call your insurance company and ask them, what they consider
satisfactory as far as a supervised increase of excersise. I would also
get them to send to you, in writing what their criteria is concerning this.
That way if you run into problems with them later you will have the
documentation directly from them. It never hurts to have it in writing. I
know that in dealing with my own insurance company it seems like the more
customer service people I spoke to the the more different the answers were
to the same questions. As my Mom says GET IT IN WRITING!! They can not
dispute what they have sent you. God Bless you and Good Luck!
— danagates
April 21, 2004
I go to Curves and everytime you come in your are scanned into the computer
and they walk the floor and supervise your workout which is only 30 minutes
and once a month you are weighed and measured and all information is kept
in your file and on the computer. Nancy
— nefish
April 22, 2004
supervised means monthly weigh ins with your doc. You should do that but in
the meantime appeal. 12 months is very long and could be seen by the State
as an undue burden and way for them to avoid coverage without excluding it.
Good luck
Gary Viscio
www.obesitylawyers.com
— gary viscio
April 23, 2004
Janice, you have to be able to read between the lines at what I'm typing to
you. Everything I told my doctor was written down in my chart all my
attempts, including diet plan, pills, gyms visits. I told my my doctor when
I started gaining weight 5 years ago I was concerned, and started making
various attempts. I also visited my doctor often while going to a gym and
allowed him to weigh me; with precription diet drugs or over-the-counter.
THE INSURANCE COMPANY gets their information from you doctor, and the
information comes from YOU. Hopefully, you have been seein the same
medical physician for a long time - as long as five years back. Any other
questions, feel free to email me.
— Anna M.
April 25, 2004
This is just a fleeting thought. . . I wonder if there is some way to force
insurance companies to pay the costs of the suprevised diets and exercise
programs they are requiring. Which I agree with gary, they are just finding
ways to not pay for surgery without having to make it an exclusion. I would
file an appeal and forward it to the president of the insurance company and
the insurance commissioner for your state asking the questions about that.
— catleth
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