Ok...another queastion plus update:)

Ok so i finally got my denial letter and talked to the bariatric center and they said that all my insurance wants is the full six months of supervised weightloss...which is only three more since I will be completeing my  third one this next week...So good news I think!? My queastion is has anyone been told that all they need is the supervised weight loss only to find out after completeing it that they want more???? They said that I fit all the other criteria and that I qualify for everything except for the fact that I didnt have the weightloss supervision...I am just hoping that I can complete my last visit in Septmeber and be on my way to surgery.... Thanks for all the support Lisa K

Lisa, I would advise you to ask your pcp (or who-ever is supervising the physician supervised dieting for you) if he/she have had other patients to get approved. Also, check on here and see if you can find any feedback on your insurance company and how well they approve...or deny. I started off on my journey on MPlan. I was on a physician supervised diet for 30 months. 18 months was their requirement at that time. They decided that they 'didn't like the way my physican kept notes' so...they wanted me to go to the SAME physician for an additional 18 months without any guidance to him as to what he needed to do to improve! I appealed and they held to the denial. I am fortunate in that I work for  company that I can switch who my insurance carrier is at the end of each year. That year, I switched to Anthem BCBS. I submitted the SAME paperwork as I did for MPlan and was approved within 2 weeks. So...depending on your insurance company...and your physician's note-keeping, 6 months may or may not be fine. I'm not trying to burst your bubble. It's an expensive procedure and some insurance companies don't mind at all making you jump through hoops to prove how much it means to you. Sherri

Lisa, I had a problem with my insurance back in AZ.  I had Cigna at the time and when both my doctor's office and I called to Cigna they told us that I needed 6 mos of supervised weight loss and I would be approved.  Well after I paid $1500 out of pocket (not to mention the 6 mos that went by) for the Bariatric Clinic's Bariatritian to do my program (only because my pcp was not on the same pager wth me).  Cigna then told me that WLS was not covered by my policy and they wouldn't cover anything.  Thank God my hubby had new BCBS insurance thru his new job they approved me in 3 days!  So I would double and triple check everything just like Sherri said cos you never know.  I would also check with the benefits coordinator at your job to make sure that it is covered under the policy.  Your employer has the option to allow or disallow WLS from their policy.  That's what happened with my insurance....normally it is covered under the Cigna program that I had but my company specifically took that benefit out.  But try to stay positive!  You have a plan in action and you are making steps in the right direction.  Positive thoughts and perseverance will pay off! We will keep praying (and fingers crossed) for a positive outcome! Hugs Andrea

My insurance required a 3-month doctor supervised multi-disciplinary weight loss plan..   Once I completed that, my insurance approved the procedure within 1 wk after being resubmitted.

I hope all goes smoothly for you as well.

My daughter is also trying for the surgery and has been advised by her insurance that she needs to complete a 6-month weight loss plan as well..  Problem is.. her doctor does not offer weight loss programs and only suggested she join WW.  I'm not sure how that will work with insurance.....

~~jackie

 

 

Jackie, I would highly recommend your daughter switching pcp's NOW. Weigh****cher's is a "diet attempt"..it is not a "physician supervised diet". If she has problems finding a pcp in her network, have her contact her insurance and ask for a list of pcp's included. If your doctor is not on board, it can make this journey extremely difficult. Since she hasn't started her 6 month diet yet, NOW is the time to get with one who is practicing modern medicine! BTW...a 'weight loss program' can be as simple as a physician giving you the outline for a 1500 (or whatever amount) calorie diet and instructing you to walk or some other form of exercise, then at very visit checking your weight & BP (should be doing anyway!), asking you how the 1500 calorie diet & exercise are going, and then writing a brief statement in his physican notes (should be doing anyway).  Each insurance may have a different stipulation as to how frequent the visits should be...but I would say monthly or bi-monthly is about the 'norm'. If your daughter's doctor won't do this then he is just downright lazy..and who would want him for a doctor anyway???? Chances are great that she would have problems getting a letter of neccesity from him, copy of physician notes, co-morbdity testing (ie sleep apnea)....all of which comes in handy to get a speedy approval. Sherri