BCBS UT-Select/12 mon. med diet/Need Help and/or Support

Hi all, I think this message will mainly be a reach out for support but maybe someone will be able to give me some advice. I have BCBS UT-Select insurance out of Texas. I have a BMI of 44 with co-morbidities. I've been dieting since I was a child (I'm 39). The following items were submitted to my insurance co: 1. Three page letter of medical necessity from surgeon 2. Letter recommending surgery from my PCP 3. Psych evaluation. The psychologist who did the eval is my therapist. I've been seeing her for 2+ years and she states in the evaluation that one of the reasons I came to her was because of depression due to my weight. 4. A list of failed/achieved diet attempts from the time I was in grade school; some medically supervised. 5. All of the test results that I've had recently (ekg, echo, barium swallow, stomach ultrasound, blood work) 6. Letter from a doctor who supervised me on medi-fast back in late 80s. 7. List of comorbidities and current meds 8. Medical record from asthma doctor 9. They didn't receive my 5 years of medical records so I'll fax that tomorrow. I called today and spoke to a very nice rep at BCBS and was told that they wanted something documenting 24 months of medically supervised diet. That would be the last 24 months. I called her back and told her that was not in the information they referred me to on the web. On the web it says 12 months. So, she was sending it back to see if it was a typo or what the problem was. I imagine like most of you I've been dieting my whole life and have tried everything. I was on diet pills for years but that doctor has retired. My current pcp put me on meridia a few years back. I'm in OA and am exercising. Have any of you met all the other criteria except the 12 months med. supervised diet (in the past 2 years)? I'm stressed and pray this does not keep me from approval. I'll be so sad. Thanks, Mary Austin, TX

I am in the process of putting up a major fight on these diet requirements. This is the tactic that many companies are now trying to avoid paying for the surgery. They are hoping you will be discouraged and go away or that your insurance will switch to some other company during that time, or maybe that you will die or get too sick for the surgery. My company "only" has a three month diet requirement in the past six months, but in my case, since I did not find out until September that the company was not going to carry our insurance after the end of 2004, and our new insurance has an exclusion, and the company did not mention the diet requirement until dragging my request out to December (two bogus denials for "experimental" that they had to backtrack on), they are essentially using it to deny me the surgery. Plus, if you have any success, they deny until you gain it back. I am fighting it, with the following rationale: 1) it's arbitrary - some companies don't have a requirement, some have 3 months, some have 6 months, some a year, some even longer; 2) it's a financial burden - I don't think many insurance companies are offering to pay for it; 3) it's more restrictive than the medical necessity guidelines of the National Institutes of Health and every other major medical association; and 4) all the medical and scientific literature says that diets do not work for the severely obese and that surgery is the only treatment shown to work. I am still fighting through all the appeals. They are now using the fact that they ran out the coverage, but I have some folks who say that if they did not deny correctly and it should have been done before the end of the year, they should still have to cover. Don't give up, this is too important.