Anyone have luck after completing 6-month requirement??
I am 33, have a BMI of 61, and like so many others here, have tried every over the counter, fad and you-name-it diet fad/plan that has come along over many years, but of course, made the mistake of never seeing a doctor each month to document it all on a piece of paper in my file. So I just got denied for WLS without having this 6-month doc supervised documentation. Has anyone out there had luck pursuing this, resubmitting it to the insurance company and getting approved for the surgery? Or do they just find another reason to deny you yet again? Tks
I had the same question. My insurance company denied the initial request, and said I have to have a medically supervised diet/exercise program. The question: if I do this, do they approve the surgery right away or do they find something else to have to do? I've already made my appointment with my PCP to start the monthly visits.
Thanks in advance for any advice.
I started my 6-month supervised diet in January for BCBS of Alabama. I did the 7th visit just to be sure (because they sometimes say the first visit didn't count as it is a consult). Got all pre-approval testing out of the way and obtained all of my medical records from PCP, nutritionist and any other consultants (psych testing) and brought them to my surgeon's office. You have to make sure that your PCP does a weight every time, you cannot skip a month and they must write a progress note outlining what diet and exercise program you are on at every visit.
I also scanned all of them into my computer in case anybody tried to say "they lost them" then I could e-mail them immediately.
My surgeon's office submitted to my insurance company for approval on 9/1 and I got approved on 9/12!! The insurance advocate at my surgeon's office said that it was because of the great documentation that they approved so quickly, as in the past she has seen it take 60 days to get reviewed.
It is my understanding that it is virtually impossible to get by without having to do the diet, so its best to just do it and wait to submit until then. Some insurance companies have a limit to appeals, so I wouldn't waste one when I knew they would deny me over not having done the diet.
Hope that helps,
Angela