Insurance decline...Appeal question

Hi. I found out yesterday that my insurance has declined my request for lapband surgery. Their guidelines say that I need either 6 months of a structured weight loss program or 3 months of 2 weight loss programs. I went to my Dr. for 4 months and WW for 4 months. Their reason for declining is that I did not have a structured weight loss program. DUH. What more could they possibly want? And I know there have been some examples of appeal letters, where can I find those. And, is this something I send on my own? My Dr. said they have a company they use that has a lawyer and they will do this. Will this cost me extra? I didn't think to ask that. If anyone has been through this, please let me know. By the way, I have BCBS of Maryland. Thanks so much.
Debbie

Debbie, Almost every insurance company requires a 6-month diet that is medically supervised. This means going to a docter every month for 6 months. The doctor needs to record your weight, height, describe his interaction with you regarding your diet and his nutritional counseling and also your response to his questions regarding exercise. The insurance companies what to see individual records of each visit prior to approval.  The rationale is that if you commit to visit a doctor regularly for weight loss, unlike Weigh****chers, you have a professional supervising your diet. That way, they understand 1) your commitment to improve yourself and 2) a professional's view of your ability to be successful after WLS. I know this is not what you wanted to hear, but I would suggest that fighting it will probably take longer than simply going back to a doctor supervised program for another 3 month period to meet the requirements of your insurance.

MD is supposed to mandate coverage despite the diet history.  Did you see your doc during the WW time?  If so, get him to provide those chart notes

Take control yourself.    Ask BCBS Maryland to see their guidelines,  customer service should be able to provide you with a copy of the medical criteria.  Also check to see if they have a form that the doctor would need to complete each time you go to them.  BCBS Michigan does reconize WW as a form of supervised weight loss.   Was there a break at all between WW and seeing your doctor.  If there was not, ask for copies of the office notes.  Make sure the doctor noted on each visit that you discussed your weight, gave recommendations etc.   You will need to provide to the insurance company these notes, your weigh in's at WW.   If there was any break - start over.  I recommend using your doctor.  Ask your doctor to be very specific in the notes.  Also keep a food journal - what you eat, etc.