Need Help With Insurance- trying to get approved

I decided to have lapband surgery, made my initial consultation, and was told yesterday that my insurance (Aetna PPO) is a stinker for approving these surgeries, and that I have to be on a medically supervised diet for 6 months prior to them approving or denying me. It took me months to finally get the nerve up to see the doctor, now I am so disenchanted I could cry. I am diabetic & have high blood pressure and need to lose @ 115 pounds. Yet other people with BCBS, for example, may need to lose 100 pounds yet not have any other health issues and they get approved quickly. Would any of you be willing to share a part of the letter you need to write that documents your weight loss attempts over the past 5 years? I feel that if I don't do this properly, I will not get approved. I have tried & failed Weigh****chers twice, and tried Dr. Phil's diet and blew that one too. I am now eating worse then before, maybe out of depression... fast foods galore & I know for a fact I am not hungry half the time & the food doesn't even taste good- it is out of boredom, anger, even happiness that I gorge myself. Does anyone have any words of encouragement before I throw in the towel?

I hope you don't throw in the towel - it is well worth the fight. It is hard for me to comment on the insurance issue, because I didn't have that problem. I was lucky. But it was a six month journey of appoinments, classes and change. You can start that and work with it. Your health is what matters - please stick with it and you will get there. Good luck to you.

I can completely understand. I have Cigna and have to do the 6 mo supervised diet and this is my 2nd time doing it. The first time it was all documented wrong and why I'm doing it, yet again. I did a spread sheet in excel that outlined my weights and various diet attempts. Along with that was a grid of pros and cons for me with WLS, medical history, medications and present health. I do have a letter but was told I did not need it. My surgeon told my that what my PCP has written is very forceful to help get this surgery. Make sure that you have your PCP head up the supervised 6 mo to include a nutri visit, psych evaluation, consultation w/surgeon and exercise/diet for each month. I am seeing my nutri each month of the 6 months, although not required. This will give me a stronger bases to get approval. What they are having me do is eat as if I was post op. That way I will have a head start and modifying my eating habits. Most of the insurance companies are doing this to make sure that we are serious about this surgery and not doing it for an easy way out, as this is such a life changing experience and a commitment for life with this tool. So take this time to learn all you can, post away and email me if you have any questions. Aetna is similar to Cigna with the approval process. They'll pay but do put up those nasty roadblocks along the way. If your heart is set on this, get your mind in the game and fight for this. I am, like many others have. Good luck, Lorraine

You have to follow the insurance co's guidelines to the letter if you want them to pay, No way around it. Most insurance co's require MD supervised weight loss plans before you are considered a candidate for surgery. SOme insurance co's will not accept Weigh****chers because it isn't MD supervised or documented. Start seeing the nutritionist & MD ASAP and start following their guidelines and have your weights documented in your medical record. Your medical records is what the insurance co will want to look at. The sooner you start the diet the sooner you're eligible for surgery. If you really want the surgery this is a test of your willingness to make drastic & permanent life style changes. Only you can decide if you truly want this surgery and can make the lifestyle changes. YOu need to address your reasons why you eat, you have 6 months before surgery to work on it. Good Luck Amy