Need some assistance with my appeal...please!!

Hi all. I am getting my appeal ready. But I am hoping to gather some info first. If you don't mind sharing, I am needing, specifically, what insurance you have and how long was your medically supervised weight loss requirement. For example: Amerigroup (Nevada Medicaid), 3 yrs.
I am finding that most insurance copies require 6 months. Mine is 3 years. Yikes. So I wanted to include that data along with all the other info I have. Thank you so much...I greatly appreciate it.

What is your question? I have UHC and I was required to do a 6 month supervised diet, but I didn't and I just won my aapeal yesterday!! I also had my PCP write a letter stating I had tried many diets plans and none worked for me.

I can send email you my appeal letter if you give me your emil address..

C

Cami, thanks for your response My email is [email protected]. Thanks for your help.

Sent :)

 I have state of Nevada heath insurance the HMO and they required a 6 month weight loss program I believe. But since I live in a rural area I did not have to do it. I did however have to go through a bunch of hoops with the doctor which I am assuming Insurance requirements like support group meeting, Letter from primary care physician, psych eval, nutritionist eval, Hpylori test, RMR test. Sorry You are having to appeal :(. Hope they approve you.

Are you sure it doesn't mean 3 years of documented morbid obesity?  UHC required two years of MO back when I had my DS.  If you haven't been MO for 3+ years, then they believe that you're not yet at the point of no return.

I second what Valerie said. I would be sure that I checked that it wasn't three years of documented MO.  Then a 6 month weight loss "progam".


When writing an appeal to an insurance company documentation is the key. Documentation of your weight and any associated comorbidities that could make the lack of surgery life threatening or signifigantly impact your life in a major way.  A letter of support from your PCP and surgeon might also help. 

Basically, any conditions that are going to cause the insurance company more pay out in the long run, vs paying out for a surgery once.  The one thing that makes sense to insurance companies are $$$'s.

Hi Valerie. I have been around and around with my surgeon's office. They say 3 years diet. I thought the same thing you did. And what is even better...I have called my insurance at least 10 times. And they have NEVER quoted that criteria. They have actually only told me the BMI requirements. I think I have a good chance. But again...the surgeon says that Amerigroup WILL NOT approve unless I have done 3 years medical diet.

So, are you really appealing to insurance, then? It's time to put on your big-girl panties and assert yourself if this fight is with the gal at the desk at the surgeon's office.  Sometimes they have a bigger god-complex than the surgeon.

I had a conflict with my surgeon's office vs insurance requirements, and I INSISTED that they submit my package as-is, promising to do whatever the insurance company responded with, because they tried to say I needed a 6 month diet, and my insurance said none was necessary.  Guess what?  I was approved in 10 days.

Oh yes!!! I told her I don't care what the requirements are, she needs to submit. She said she is. I am going to call the insurance case management department and ask.You were truly blessed. I am praying like crazy!!!! Thanks for your support girl!!!