Denied a referral for not having 6 mo. phys doc. diet

Hello.  I was denied a referral by my medical group (Blue shield hmo -memorial care ipa) for not having 6 months of a physician documented diet.  I have never done it so no proof.  My bmi is 60.  I have over 200 to lose.  I have an appeal letter written up.  Any advice or good news from anyone whos gone through this please email me at [email protected]  .  I don't have sleep apnea or diabetes but am hoping with my bmi and other issues it will get approved.

Thanks in advance,
Lisa in So. Cal

 darn that sucks so badly. They are so stupid. What is wrong with these insurance companies? Of course if we stick to a diet recommended by a doctor we would all be skinny! The point is we can't control ourselves. That's the whole point of the surgery. Just keep trying to get approved.

Exactly!  I'm with you sister.  I noticed that you have Dr. Leport... I am also going to that center, hopefully.  I've been attending the Monday support groups at OC Memorial.  How long did it take you to get him as your surgeon if you're using him?  I am mailing out my appeal/documentation tomorrow.  Wish me luck!

What about high blood pressure? Do you not have a doctor that you have went to that will show that your weight has been up and up for years, with ill affect to your health? How about back problems, leg pains, anything that you can think of. A letter from you general doctor asking for your approval?? I had the surgery back in 2005, and had Atena, and was turned down the first time,even though I had done the 6 month diet, the physical  and phsycological thing that they req. But I did not lay down, I wrote a letter, my doctor wrote a letter, and I referred that I was at the place of needing back surgery and had just so happened to have had a doctor check to where my blood pressure was extemely high that was documented, right before my request for surgery, that was documented and med were prescribed (had never been on blood pressure med before). After all that the denial was overturned and I was approved! Dont give up, I pray you get this chance! Blessings,, Keep us informed.
Clytie

I do have high bp and hi cholesterol.  I do have records and am sending those along with my appeal.  No back probs but knee issues starting.  My general Dr. is the one who submitted an request for an authorization for the referral.  I am sending out the appeal via certified mail with pictures of the edema in my feet and legs, pictures of me, documentation from appointments wtih my Drs. showing my weight and issues attributed to morbid obesity.  Thank you for your help and wishes!

Lisa

Sweetheart I know that you feel like you are running into a brick wall, BUT, I did the 6 month diet, exercise therapy, and physcogist, which at the time Aetna required, so I think the important thing to do is to make sure what the requirements of YOUR insurance are in order to get approved, make a copy of these requirements and follow them to the letter and document, document, document! I went back to see my doctor every month for 6 months and diet try to diet, but lose a few pounds and gained them back and lose and gained, just like I had all my life, but the important thing was that the doctor documented I was there because I was on a diet plan (the pyramid plan is good, this is just the balanced diet you learned in school). Then fight, and dont give up, when you reapply. You will know that you have met all the requirments because you have followed the policy to the letter. I know right now, you are sad and dont want to wait another 6 months, but if you dont, where will you be 6 months from now. Still unapproved and stuff in a feeling of desperation. Right??? I am trying to encourage you, I know it sounds like a lot to juggle, but Believe me it is definately worth the effort! Keep us informed, blessings and prayers are with you. This group can be a great support system, let it me just that. In turn I am sure you will be an encouragment to others.
Saved by Grace,Clytie

 why don't you just do your 6 month diet?  I am doing mine.  I didn't think there was any way to get around it.

Did you ever try Weigh****chers?  I had saved ALL my weigh-in booklets over the years and those were sufficient.

Anna

I did weigh****chers years ago many times but don't have any booklets.  : /

If that is what your insurance requires, you will have to do it. Start it this month and do it through July, and you can re-apply then. Many are required to do this. I don't think it is appealable.
-Wanda