can't believe it!

I am so upset I want to cry.  I have broken tubing from my band.  The band is no longer helping with weightloss.  So, my doc suggested doing a revision and taking out band at the same time.  I just found out today after waiting 3 wks. with pain at times, that my insurance company wants 6 months documentation from a Dr. that I've tried to lose weight.  Hello?  I'm hurting, I need a revision.  Does anyone know if Weigh****chers would count?  I've been a member for 5 months.

Thanks,

Donzelle

I'm so sorry your going through this!  Weigh****chers counted as part of my original wls requirements.   

Donzelle,
Sorry to hear of your denial, but keep the faith and plug along.  Insurance companies want you to quit, don't give them the satisfaction.

Appeal and hire a lawyer if necessary.  You have a mechanical failure.  Make sure you save all the weigh****cher's sign in's and have your Dr. weigh, counsel on nutrition, behavior modification and weight in the mean time.  Get started in case you need too, they said the same thing for me but we got it on mechanical failure.  If you have proof of that make sure that is part of your appeal.  Do you have Bariatric weigh in's as well, make sure you include those and that you have been following your food plan, etc.  Document everything, especially if you are talking to someone at the insurance company.  Who, Date and time, conversation, etc.

Deanne

Thanks Deann your post was very helpful.  Unfortunately now they are telling me I have to be morbidly obese for 5 yrs. before they can do a revision. I can't believe it.

Hi Donzelle,
United Heathcare said the same thing for me and we got around it once I hit the BMI of 40.  They had really no criteria for revisions, so they used the same criteria for a newbie.  Fight them with all you've got.  Don't give up.

Hi Donzelle... I had the same....a broken band somewhere.  I wanted a conversion and my insurance company does have a 6 mos I can change program.
The insurance company told me to have the doctor put a specific request in to have this waived. Afterall..I had spent 3 years under the bariatric umbrella....and the insurance company accepted me and did NOT make me take the 6 mos I can change program.
You could also appeal the decision while you do the 6 mos documented weight loss. Your appeal could come first.
good luck.
Joan

I have a friend that went through that too.. Weigh****chers does not count ,if your insurance says DOCTOR'S followed diet, That does mean Doctor. Period. Not just documented by anyone any place....Take care,  Alizka