American Community Insurance Dilemma

Hello everyone. I have a dilemma with my insurance company. I live in Indiana but my insurance is American Community which is through Michigan. I found out my request for Roux-en-Y was denied due to no doctor supervised weight loss programs. Here in Indiana there is a new law that takes effect on July 1 stating they can only require 6 months of the doctor supervised dieting but since my insurance is through Michigan I must go by the laws in Michigan. What is the wait time there? American Community has not been real helpful is answering my questions as far as how long I need to do this dr. supervised plan. I am afraid they are going to come up with something different to to delay my surgery after I have completed the supervised weight loss with my family doctor. I need your help in getting this figured out. All help is appreciated. Regina

Hello Regina, It depends on your insurance requirements. For example, my insurance required 12 months within the last 4 years. However, Aetna requires only 6 months. Your next phone call needs to be with your insurance carrier and find out what you need to do. My wls doctor had an insurance worksheet that needed to be filled out before my first consultation. That is how I found out how long. Good luck, Tammy

Ahh yes, I remember American Community all to well.. They were my ins. company when I tried to get approved for GBS. I would have to assume that since they didnt specify how many months of supervised weight loss programs that it doesnt matter just as long as you attempted. Did it specify in the denial letter? Resubmit your request and giving them all the documentation of weight loss attempts, supervised and unsupervised. I went through 3 denials with AC and I DO know how they work. They wont be helpful. Dont back down!! They tried telling me that it wasnt medically necessary which my BMI was over 64 along with major co morbs. It was their way of trying to get me to back off. I got my surgery 5 yrs ago and they paid for everything.