denied, 12 month DR supervised diet

(deactivated member)
on 12/13/04 7:03 pm - Clovis, CA
Today I recived the call that I have been denied. The nurse told me that I needed 12 months of a dr supervised diet programe. This is the exact wording of my coverage involving treatment of obesity. (in the exclusions section) 18. Services primarily for weight reduction or treatment of obesity. This exclusion will not apply to surgical treatment of obesity if: �� surgical treatment of obesity is necessary to treat another life-threatening condition involving obesity, and �� it has been documented that non-surgical treatments of the obesity have failed, and �� procedure is considered by the Plan to be Medically Necessary; Is there any way that I can appeal this?? If so how should i go about starting. Also, are they saying that if i can provide the documentation after a year that it is medically necessay? Or will I go 12 mos just to be denied for another reason all together...Thank you in advance for any and all advice. CJ
CuteDonna
on 12/15/04 7:49 pm - Effort, PA
I appealed and used Gary but I still did the 12 month diet anyway and I got my surgery. Do the 12 months and get as many of your Doctors to write letters on your behalf. I had ALL my doctors write letters and send them to my surgeon. Best of luck. Donna
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