denied again....

OK I get it, they are not going to budge without a doctor supervised diet so I went Monday to my pcp and she got me started, I have to keep a food and exercise journal and I will go every month to get weighed in that should push me into November. I am ok about it just mad about all the wasted time. I am still going to appeal until I am blue in the face, because when I called them back in January to check on my coverage for gastric bypass they told me they cover it. The surgery just has to be deamed medically necessary, there was not one word mentioned about doctor supervised diets. So that is why I am going to keep appealing. One way or another I am having this surgery. Take care all Dana

Hi Dana, Keep that fighter attitude, you will get there! I'd be irritated with the wasted time too, sometimes I swear it's like some club where you can get the answers as long as you know which questions to ask...oh yeah and who to ask and when to ask them, only then do you get to learn the secret handshake grrrrrr. I get really pissy when it comes to red tape. We are here to support you all the way, one of these days we will be sending you the walk sip and breathe emails too! Linda

I know how you feel. I love your "fighter" attitude. Keep positive. It's going to happen for you too.

Thank you Dianne, you hang in there too....it is going to happen for both of us. Dana

if there isn't any mention of a supervised diet.....then you don't need one. as long as you meet their requirments they HAVE to approve it. is there a way you can get a copy of your insurance handbook? it might even be online. if you pay for insurance and they say the cover something that you meet the requirements for by law they must pay for it. it is not very expensive for you to go to a lawyer and have him write them a letter. most times that does the trick. when you appeal it is very important to have a copy from their handbook with the outline on how wls is covered and send it in with your appeal highlighting important facts in your case. insurance works by facts only , not feeling. so writing a letter tell how awful it is to be MO won't work and never will. just write the facts on your medical history. what really makes me mad is if someone had blocked arteries and need surgery , insurers wouldn't make them have a supervised diet history...how crazy...plus not very legal if you have been deemed medically nessasary. best of luck and if there is anything i can do to help please email me.

Dana: I am so sorry to hear about your insurance troubles. I agree with what Fran said. You need to call the insurance co and ask what their guidelines or criteria is for WLS. Here at BCBS of De we only need the BMI,height, weight, cardiac,psych and pulmonary clearances. We never even ask for the drs supervised diet plan. Give them a call. It can't hurt and keep the faith. Anne

That's true. I had BCBS of DE at the time of the surgery and was never asked for a dr. supervised diet of any kind, just the info Anne mentioned. Hang in there, sweetie! Do as Fran suggested and see if you can't fight them with their own words. (((hugs))) -Karen

Dana, Whoa girl. Try to stay focused with the end result in view. I must say they are being awfully picky. I know over the years I did Nutri system, weigh****chers, phen-phen from 1 dr. and Wellbutrin from another, so I guess that was enough documentation over the last 20 years for Aetna. Dana, I did not share with my co-workers or family until the last month. I only told my husband and 2 daughters. I didn't even tell them for almost 5 months. I'm so glad I didn't tell anyone. You're right about the negative attitudes. I know I couldn't have handled them very diplomatically. But now everyone knows and they all say how brave I was. I didn't see it as brave. I saw it as being concerned about my health and that this was a last resort for me. Thank God everything has turned out ok for me, but I was spiritually prepared it it didn't. So God is good. Life is great. And you will have a few months added onto your journey. We all love yopu and know how much this means to you, so we'll keep on being there for you. ((HUGS)) Elissa