6 month diet advice

Several weeks ago someone asked whether they should wait and do the six months or appeal.  At first they were told an appeal was a waste of time.  In my experience it is not.  You CAN appeal while you are doing the six months.  At worst you get two chances to appeal then.  Once before and once after the diet.    My office does this all the time Well, guess what................ SHE WAS JUST APPROVED .......................................... Gary, Thank you so much for advising me to send an appeal in.  I got a call today from the insurance company and I have been APPROVED!!!  I havent got it in writing yet, but I have a verbal approval. Just prior to you writing to me, I had decided to just wait a few months while I finish the 6 month diet.  I had been advised that an appeal would be a mistake.  Thank you Thank you for advising me the other way. L

gary viscio wrote:

Make sure you send that appeal certified or something that will verify it was delivered. Good luck and keep me posted. Gary

lindven wrote:

I have got all the documentation together...35 pages.  I am going to wait until I talk again with my PCP after the holliday (he is out of town)  I am hoping to get some more detailed info from him.  If not I am sending what I have in.  I only have a little over 2 weeks before the 30 day appeal deadline is over. I know that as of January 1, 2007, the 3rd party  that does the case management for my insurance company will no longer be handling it.  The administrator of the insurance will be handling it.  I hope this doesnt create too many additional problems.   Thanks for your advise.  Because of what the other poster wrote to me, I had just about given up on doing an appeal since he indicated that it would hurt me in the long run.  I appreciate your educated advise! Thanks, Linda

gviscio wrote:

Linda, Send them everything.  All records and reports,Get your PCP to be more detailed.

lindven wrote:

You responded to my post on being denied due to lack of 6month MD diet.  I wonder if you could give me some futher advise. Here is my background info BMI 42 Sleep Apnea GERD Hypertension stress incontenence joint pain My insurance requires: Thyroid history; Medical history including recent physical; Height Weight BMI; Cardiac/Pulmonary Clearance; Psych Evaluation; 5 year diet history; and accumilation of 6months MD supervised diet with 3months consecutive. I have all of the information except for the MD supervised diet.  My PCP wrote a second letter when they requested this documentation and included a chart of my weight loss over the past two years.  It included more that 6 months, but it didnt come directly from his medical notes.  I didnt go and get weighed in each month, but he was aware of the diets and was basically vouching for me that I did these. You suggested in your post to me that I go ahead and try to appeal meanwhile doing the 6month diet...which I am in the 2nd month. What items should be included in my appeal letter and what documentation should I send in addition.  They should already have all the letters from my PCP; past PCP; Pulmonologist; Gynocologist; and WLS Surgeon.  Do I repeat this info. Any help you could offer would be much appreciated. Thanks Linda

Great advise Gary.  Thanks for taking the time to post so much helpful information!   Christie

My story is somewhat similar. I began a 6 month diet & educational program at the same time as I began the appeals process. I just began month 4 of the program and the insurance company backed down. They granted me an authorization to see my surgeon. It is likely that I will have surgery (if scheduling permits) before the 6 month program would be over.

This is exactly what I wondered about.  Thank you so much for sharing this and best of luck with your surgery and recovery.

I was denied one week after submitting my papers - reason "no documentation of a medically supervised diet". Insurance company would not discuss with me, only with my PCP.  My PCP found out for me that they required 6 month medically supervised diet.  I see my PCP every 3 months.  Insurance company said to keep a diet and exercise log and keep my regular visits.   I still had diet logs on my computer from last year (self made templates-following WW plan and format)  - April through about November.  I submitted those records along with another letter from my PCP, detailing notes in her charts for what I was doing at the time of visit. I got the call yesterday - I'm approved!!!!! It's worth sending in whatever records you have.    I have Carpenter's Health Insurance - Self funded plan, administered by GHP Coventry. Ann