Help!

My husband was denied by BCBS PPO because they said he had insufficient weighloss history. He was never really monitored by a doctor for weightloss but has tried many things. What should we do?

Probably the same thing I am going to have to do - see my PCP and get started on a physician supervised weight loss plan. I know it will set his plans for surgery back some, but it's probably what he will have to do. Unless, maybe his PCP could submit a letter stating that the surgery is medically necessary. Does your husband's PCP have any records at all of his weight gain in the past 2 years? Maybe they have something documented in their records where your husband may have mentioned trying to lose weight, a specific diet he was on, weight related illnesses, etc. Just a thought. Good luck.

Thanks for your suggestion. My husband was on Phen-fen for a while and it was documented but they said that was not enough. Do you know if know if there is a format or template that we could use?

Tammy gave you great advice. Get your husband to the PCP! Most men are resistant towards getting medical care anyway. He probably needs a good check up, and the doctor will put him on a diet. In the interim, write the insurance company and request a copy of their UTILIZATION REVIEW GUIDELINES FOR WLS, and copies of all documents and opinions used to deny his request for surgery. Make sure you send this FED EX, UPS, or certified mail, return receipt requested. Follow up by phone to make sure they comply. Let us know what it says when you get it. Fight the good fight! Roberta

Thanks for your suggestion. You are exactly right about men visiting the doctor. The only reason my husband went to see the PCP is because he needed a recommendation letter from a PCP. However, there is not a whole lot of medical documentation available for him that would show that he was on a supervised weightloss program. I will keep you guys up to date with our progress. Thanks!