Denied - 12 month doctor supervised diet

Hi Everyone!! I found out this week that my insurance company has denied my claim for WLS due to not meeting one of their criterions for WLS. They could not find the documented twelve month doctor supervised diet in my medical records for the last two years. However, I was on a 12 month supervised diet with my doctor back in 2003. I was taking the prescription diet pill Meridia from January 2003 until December 2003. My doctor (at that time) only made notes in my medical file about my blood pressure was elevated (I take high blood pressure medicine) during my monthly weigh-in visits. There only two references to the Meridia prescription: One in February and one on July. I switched doctors in December 2003 when the doctor suggested the Cabbage Soup Diet for me to lose weight. I was not aware of the Cabbage Soup Diet so I looked it up on the internet. Once I saw the requirements of this diet....I decided it was time to see a doctor that could help me lose weight. The new doctor took me off of the Meridia and couldn't believe I had been taking it for almost a year with my high blood pressure. She suggested Weigh****chers. I tried it....I quit after four months because I couldn't lose any weight. What are my chances winning the appeal with the prescription history containing the Meridia and the doctor's name that prescribed it to me? I was able to get the prescription history from the pharmacy I got the prescription. It has the doctor's name that prescribed the Meridia to me. It also shows my first prescription started in January 2003 and my last prescription was picked up at the end of November 2003. I should be getting my denial letter in the mail within the next couple of days. So I want to start on my appeal letter as soon as possible. I appreciate any help you all might provide to me..... Thanks!! Linda Armstrong

Send them a copy of the pharmacy thing along with a letter than it was so important to you to lose weight that you endured taking the added risk of the medicine with your high blood pressure for a year. Then you did weigh****chers for 4 months under the second doctor... Tell them that they are asking you to risk your health further, by making you delay (when it is obvious that you have met the criteria), in an attempt to save themselves a small amount of money. The damage you sustain by staying at your weight with high blood pressure, will end up costing them more in the long run.

Why can't you call this Doctor that put you on the meridia and ask him to write a letter stating that you where on Meridia and on 12 month supervised diet? Can't hurt to try. Unless the insurance company was like mine and did not want any breaks in between those 12 months of dieting. Meaning that they did not care if I did a 12 month diet back in 2000, it's 2003/2004 so we want a 12 month diet for those years. Donna

I knew if I asked the professionals...You all would come through with some good answers!! I got my denial letter today in the mail. It states that I am not eligible under my health care plan because the documentation provided does not meet MPM criteria. My body mass index is 38 and there was no documentation of medically supervised weight loss programs as required by the MPM. I asked the claim rep was MPM stood for and she couldn't answer me. I had to look it up on my insurance's website and found it stood for Medical Policy Manual. I found the criteria for obesity surgery. I going to try to get the doctor that prescribed me the Meridia to write a letter stating that I was on a doctor supervised diet for more than a year. I was taking the prescription drug Meridia for eleven months on the diet. I have three out of four of the co-morbity conditions required when your BMI is under 40. I am going to stress this in my appeal letter. Thanks for all your help!! Linda