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Welcome!
Kim  

Kim,

That really stinks!!  I am in the process of going through the 6-month physician supervised diet visits and what you have written has scared the hell out of me!  I am curious, did you loose much weight during that 6month period.  (I really haven't, and it has been 4 months, and I'm afraid because of that, that I will get denied.)  It really sounds like you have taken the right steps to appeal their denial.  So I see you wrote, 'denied again' is this your 2nd denial?  And do they keep denying you for the same reason?  Just curious.  I hope you can get everything to work out for you!  Keep us updated!

DENIED AGAIN
"The request for the surgical treatment of morbid obesity is being denied as the following criteria listed below has not been met:
*It is expected that appropriate non-surgical treatment should have been attempted prior to the surgical treatment of obesity.  Non-surgical treatment of morbid obesity appropriateness criteria:
Medical record documentation of active participation in a clinically-supervised, non-surgical program of weight reduction for at least 6 months, occurring within twenty-four (24) months prior to the proposed surgery and preferably unaffiliated with the bariatric surgery program."
And then they went even further with this:
"A program will be considered appropriate if it includes the following components:
1.  Nutritional therapy, which may included medical nutrition therapy such as a very low calorie diet such as MediFast or OptiFast OR a recognized commercial diet-based weight loss program such as Weigh****chers, Jenny Craig, etc.
2.  Behavior modification or behavioral health interventions.
3.  Counseling and instruction on exercise and increased physical activity.
4.  Pharmacologic therapy (as appropriate).
5.  Ongoing support for lifestyle changes to make and maintain appropriate choices that will reduce health risk factors and improve overall health."

I am so disappointed,  angry,  pissed off,  frustrated, and upset  !!!

BUT I refuse to accept their denial.  I absolutely need the surgery and the lifestyle changes, and the emotional support, and the physical transformation.  I cannot give up.  I began an appeal process yesterday with letters.  I'm assuming that the staff at Dr. Eibes' office will be doing the same, but I just feel like I need to speak up for myself.

First I wrote a letter to every WW location where I have joined over the past 10 years and asked that they forward every record of my joining and my weight records to BCBS and me.  I cc'd Dr. Eibes, my PCP, and BCBS on the request. 

Then, I sent a letter to my PCP w/a copy of the denial letter and asked that she send BCBS a letter (and a cc to me) providing detailed information regarding the activities that ensued during my 6-month supervised non-surgical program that I completed with her between October 3, 2008 and April 15, 2009 PLUS I asked that she provide her professional opinion as to whether or not I could benfit medically from having WLS.  I cc'd Dr. Eibes and BCBS on that request too.

Next, I am going to write a long and detailed letter to BCBS and I am going to advise them that their denial is not acceptable to me and all of the physical and emotional reasons why I need to have the surgery.

If anyone has any ideas or suggestions that might help me during the appeal process, PLEASE do not hesitate to share.  I need all of the help that I can get.  Also, your prayers would be greatly appreciated. 

Cheryl,

Glad to hear your surgery went well.  I have been thinking about you.  Are you still planning on going to the Chicago OH event in June?  I'm still shooting for October for a surgery date.  Still jumping through hoops as of right now! 

Take care, 
Carol B

I had Title 19 also and went through a 6 month diet with a dietician.  I gained 30 pounds while following the diet strictly, was still approved for surgery.  Title 19 has a million and one hoops to jump through so if you're impatient you might want to take a deep breath and settle back.  Keep in touch with your primary care physician and your surgeons office, get all paper work that needs to be done and start ticking off the sheet.  By the time I was done with the 6 month diet it took 3 more months worth of testing before I had my surgery.  There is a LOT of pre op testing to do.  Go to the weight loss seminars regaurdless of whether you've had the surgery, start working on changing your eating habits and exercising now, it'll make it that much easier in the long run.  Once you get past the insurance approval they set a surgery date FAST.