Doctor won't submit my letter to ins

She says they NEVER approve of WLS w/o you going through a 1 year medical weight loss program. This has to be done at the hospital. Is this true? Have all of you been through one of these? They said it can't be WW, Jenny Craig, etc. It HAS to be w/ a doctor. I'm not buying it. I'm pretty upset right now. I wonder if my insurance would cover a prgram like that. All I need is another set of people telling me to eat rabbit food and exercise for a full year. I'm so frustrated I want to cry but I'm at work.

Well I was told that if a VERY STRONG letter of support couldn't be obtained by my PCP that my insurance company would require 12 consecuitive months of doctor supervised diet. I however am VERY lucky that my PCP is on board and willing to write me a support letter (aka medical necessity letter) for submission to my insurance. Does your PCP support WLS? If not that might be one reason he/she is not willing to "help. If I were you I might try to find another PCP that IS willing to help. Good luck!!

I can't go through another year of this. I'm 327 #s, BMI is almost 60. I have lots of medical problems. I asked the doctor's office to put it through anyway. They said they CAN'T. I have BCN. I can switch to HAP at work. Are they better or worse? I'm trying so hard not to cry at work. In another year I'll be over 400 #s and maybe dead.

Get another doctor. I have BCN and my doctor was more than willing to send in the paperwork..with documentation of my co-morbidities. Make a dated list of all of the diets you have been on. Submit it to the doctor to include with her letter to BCN. From what I have read on this board, HAP is hell and almost always does an initial denial. I live in the Warren area and would be glad to share doctor info...write me at [email protected]. Diane

HAP is no better. They do require 12 months medically supervised, so if your doctor hasn't documented that he/she has seen you regularly for the last 12 months and counseled you on diet, exercise, and behavior modification, you're screwed. Sorry to be a downer, but thats just the way HAP works. My first request for a referral was denied, I now have to appeal, but likely still will not be approved without that 12 months of documentation. Ive seen a couple sets of my medical records (Ive requested them from every doctor Ive seen in the last 10 years) and none of them have been very good about documenting diet/exercise instructions. However, if you can at least get your first denial, you can appeal however many times they allow (HAP allows two appeals). If they still deny you, you can appeal to the state insurance commission and they can overturn your insurance company's decision. But, I was just told earlier this week the state used to be very patient friendly but of late is becomming more ins company friendly. All you can do is keep fighting short of winning the mega millions.

My surgery was approved on the first try (submitted by my surgeon) and WITHOUT any letter from my pcp. I see a physician's assistant at my pcp's office who is obese and does not believe in wls, so she refuses to write letters. As a result, there was no documentation of any weight loss program for me outside of weigh****chers. I would hope that if I got approved without any of that then you should not have trouble. Good luck to you!! Bekki

My insurance said no weight loss program , no surgery but they paid for a year of weigh****chers for me so they had the records. I've heard that most insurances require a year of a supervised program.

You need another Doctor. My insurance approved me first try and all I have is medical records that only show my weight (which has always been up there) and I had to document all the diets and exercise programs I have been on. My insurance company did accept JC and WW. I was on WW. The key is to find a doctor that will support you and do what is necessary for you to be approved. Don't give up hope. I'll be praying for you.

Call Dr. Webber! He can get your files and write the letter for you, he did mine all the way to the end. bcn does require the diet attempts, but i didn't have any in my records , dr webber sent the appeals and wrote why it was so urgent for me to do this right away. I do have a great pcp, but didn't even ask him to do it. I would however find a new doctor who is going to be more supportive. Hugs Linda

Your profile says you ended up waiting a year anyway. I'm just going to do it. On Dr. Webber's hospital page, there's a thing to fill out to see if you would qualify. I have a number of health problems so I'm good there. It told me after I filled it all out that I wouldn't qualify because I need 12 months of supervised diet. God must be telling me to do this first. So I'm doing it. *sigh* It's just such a smack in the face.