Two different answers from my ins. co

I called my insurance company today for them to send me something that instructs their requirements for approval.....Then I asked the guy some questions about requirements, especially about the doctor supervised programs and he said there is nothing saying anything about that....My doctor just has to basically "prove" that I would benefit from have WLS... but the person I talked to last time said there had to be 2 different diets with doctors for at least 6 months....So now I am totally confused...What would you do?...Who should I consult with?....Thanks bunches....Kelly

It would be helpful if you posted which insurance co you were using so someone who has dealt with them can share their experience.

Sorry....The ins. I have is Care Source.....

Kelly The following E-mail was sent to me by an Insurance Rep. at a surgeon office Jimmy, Unfortunately, we do not have a working scanner presently, so I will have to type Caresource's requirements. If you would like me to mail you a copy to your home as well, I will be happy to do so. Okay, their listed requirements are as follows: 1) Patient needs to be at least 21 years of age 2) BMI must be 40 or greater. A BMI greater than 35 could be considered if co-morbid conditions are severe enough and all other conditions are met. 3) There exists a co-morbid condition that is either poorly controlled on appropriate medical therapy and would likely improve with weight reduction or by virtue of family history and existing clinical conditions the patient would remain high risk for short term co-morbid complications without the surgery. Examples include: A. Poorly controlled hypertension on multi-drug therapy B. Brittle diabetes despite high dose insulin treatment and other therapeutic regimens C. Strong family history for a lipid disorder, coronary artery disease and early MI or death 4) The patient must have participated in at least two 6 month trials of diet and exercise that failed to achieve lasting weight loss. These attempts need to have been either physician supervised or documented as serious attempts by the attending physician 5) Written clinical documentation and supporting information from the attending surgeon must include: A. A letter of medical necessity. B. Evidence that there have been adequate conservative attempts at weight loss C. Summary of co-morbid conditions and attempts at conservative treatment D. A description of a multi-disciplanary approach to preparing and managing the patient in the pre and peri-operative periods through an extended post-op period. E. Evidence the patient has been evaluated from a psychological standpoint which supports the patient will withstand the rigors of surgery and maintain longterm follow up care As I said in my previous email, according to their requirements above, they indicate two 6 month trials of physician supervised weight loss (equal to 1 year). However, recent (in the past 4 weeks) correspondance is indicating only 9 months is needed. Also, it appears the only surgeries they cover are the bypass and vertical banded gastoplasty (VBG)---not the Lap Band or DS. Please let me know if there is anything else I can do to help. Good luck!

Jimmy.....Thanks so much....that info was just what I was looking for to take to my doctor....You are super....Hugs...Kelly