Scared Insurance will decline

Please Help... I turned in my medically necessary letter with the notes from the dr. The bariatric clinic saids its not enough. The insurance wants 6 months consecutive. I only had notes for once a year. What else can I provide to show that I really need this surgery. I am really desperate and scared that the insurance will decline. Please if anyone has any idea of what other information i can provide to the insurance to help move on the approval process.

Hello, Don't Stress over it. The 6 months usually is a MUST, just get started with it. I was denied by my ins a few weeks ago & in the middle of appealing. I am, as well as hundreds of others are desperate for WLS. Some on this board have waited YEARS. I started my whole WLS process 10 months ago. My ins. wanted a 6 month as well as my weight for the past 5 years. I'm not sure what else you can provide to the ins, seeing there is no way getting past the 6 month thing to my knowlwdge. Make sure when your doing your 6 months, go to every appt, EVERY month, dont let 1 skip, or you might have to start all over again. You can check into obesitylaw.com Send them an email with your info & maybe they can help you. An appeal letter cost $450.00 & the next step is $850.00 & it goes up from there. They will email you back weather they think you can win or not. Good Luck!!

I read your post to Jasmaine. I hope she, too, gets a copy of this post. I agree with everything you said and agree about contacting the lawyers. This can be a long, drawn out process and the insurance companies don't make it any easier. I had to do 6 months consecutive and found out I could do 3 months with my PCP and 3 months with my surgeon. You see, the surgeon is going to tell you to star****ching the carbs and cutting back on the sugars. They'll have you talk to a nutritionist and all that counts. Fortunately, for me, my PCP knew EXACTLY what my insurance company wanted to see in the paperwork that was submitted. I weighed in at her office every month and took a different drug (or told her I did). I didn't want the dang drugs to work so I looked up the side effects and reported them back to her so my paperwork looked right. Hey, they want to play a game, I'll play a game. Her records showed I'd been overweight forever. Why 6 more months. They think we'll give up. WRONG. The my surgeon....he weighed me every month and that counted. He noted what "dieting" methods I tried for that month and it all worked out. I have high blood pressure, caused by weight which was a plus. I have arthritis in both my knees, caused by weight which was a plus. I had a sleep study test and had apnea and needed a CPAP machine. Apnea is cuased by weight so that helped. Everything you can "blame" on the weight is in your favor. I also have an inactive thyroid, partially caused by yo yo dieting....made it a plus. The 6 months seemed to drag at first but once I got to my surgeon and started on his routine, the time moved more quickly....so it seemed. But, hang in there. It will happen and when it does, you'll know how worth it all of this really is. If your insurance company denies you because they still call the band "experimental", contact Don Mills as INAMED and he'll help you from there. www.inamed.com Good luck...to both of you. If I can answer any questions for you, please let me know. I'd be happy to help if I could. La Wanda 308-248-200

Jasmine- You want to talk to your insurance company and find out exactly what the criteria for approval is before you do anything. Some insurance companies want you to do a medically supervised diet, some do not require it. Some just want you to supply a diet history. But the thing is you will not know what they require until you ask. If they do require a medically supervised diet there is not too much you can do to get around that. You will also need to document any co-morbidities your obesity has caused. Do you have high blood pressure, diabetes, arthritis, sleep apnea or any other illness that is a direct result of your obesity. Generally your insurance is not going to approve the surgery unless you can document at least one of these illnesses. Every insurance company is different both in their requirements and in their process. So your best bet is to call your insurance company and find out: first, what are the qualifications for the surgery i.e. 100 lbs overweight and one co-morbidity; and two what are the requirements for approval i.e. supervised diet, letter of medical necessity, psych eval, etc. The more you, yourself know about the process the better able you will be to stay on top of your paperwork and be sure it all gets done correctly and done on time. Red