Anyone get around..............

The 12 month supervised dieting that BCBS of IL (PPO) requires?

I am currently fighting a 3 month diet requirement that is being used to completely deny me the surgery, as they told me about it on 12/9/04 and the policy expired on 12/31/04. I am appealing it based on the fact that the National Institutes of Health and every other major medical association that has guidelines on this do not have a set diet requirement, only that the patient has failed to lose weight by conservative means. Since I have been dieting for well over 20 years, that should be enough. Here are the points I have raised: 1. The requirement is more restrictive than the NIH and major med associations. 2. The requirement is arbitrary because some insurances don't require any diet, some are 3 month, 6 month, and 12 month. What will keep a company from delaying treatment by requirement 2 years or 5 years? 3. The requirement places an unreasonable financial burden on the patient, as most require diets that are very expensive. 4. All of the medical literature out there says that dieting is not an effective treatment for severe obesity, and the only effective treatment is surgery. 5. My plan denied you if you lost approximately 10% of weight in 3 months, at least until you regained it, delaying treatment even more and placing health more at risk. Plus 10% of my weight would not move me out of the morbid obesity category. I am still fighting on this and hope to have some good news soon. Hope these points help. If my letter to the company and Ins Dept would help anyone, I'd be happy to share it. Good luck in your fight.

Wow!! You have been a great source of information! I really appreciae it!! I would really love for you to share your letter with me. I just know that I am going to get denied by BCBS of IL because I have not done the year of supervised dieting. You can click on my email at [email protected] Hope to chat with you soon.