SIX MONTH DIET

I just go approved by health net in nj today. 5 weeks of sending back and forth. Went for a level 2 appeal today. It was a face to face sit down with doctors and nurses and a teleconference to corp.Office. After I talked for 15 minutes as to why 6 months of diet is bs because their is no scientific research saying it will help. If you have 100 pounds or more to lose there is only a 3% chance that you will take it off and maintain it. I asked them for the reason and silence. Also told them pay now or pay much more later. Was up front with them that your pcp and you could make up 6 months of notes, but you do not lie or cheat in life and want to be an honest person. Not one question asked by them. Leff and 10 minutes later called my cell to tell me I am approved. Do not give up and you will win! Best of luck to all in their journey for WLS.

Richard I'm so happy for you Some insurance companies won't budget but it don't hurt to fight it if you want to get out of the stupid 6 months, in my case 12 months of dieting. Donna 338/153

I am so glad to have found your post - and I wish you much success with your upcoming surgery! I am going through this exact same thing with HealthNet. I have met all requirements including the six months diet but I do not have six consecutive monthly weigh-ins. I can't say they've specifically denied me yet but my surgeon's office said my PCP has to send in six separate reports showing my weight and blood pressure for each visit along with notations that I was counselled on weight loss and exericse. I saw my Dr. last June, August, November, December January and now made an appointment for this week just to make a fourth consecutive. I was on Meridia until January - which I count as my obvious six month attempt. I am going to make sure that when I see the Dr. this week he faxes in those reports (if he hasn't done so already). It is ridiculous and just a stalling tactic I'm sure. I've placed a call into the LPN assigned to my case for preauthorization but she has not called back. I have to believe that if I were able to speak to someone I would win. Their policy says six months not six written forms. Anyway seeing your victory has given me some more hope. I am really hoping not to have to delay another 2 months. I had even told my job I was having surgery (of course I didn't say what I was having) and so they've planned for me to be out two weeks. But enough about me and back to you since things are winding down to your final days. I'm sure you must be so excited - heck, I'm excited for you. All the best! Susan

you wrote........If you have 100 pounds or more to lose there is only a 3% chance that you will take it off and maintain it........ I'm in the same boat with the stupid 6 month diet. Dr. worked with me while I was on Jenny Craig over the past year but didn't note anything in my file. She did write a letter - well a short note - stating that she has monitored my weight over the past two years. They won't accept it. Do you know where I can find articles / studies showing there is only a 3% chance of taking it off & maintaining it? Before I self pay I wanted to try one last time. I have Highmark and they're a pain. Thank you so much and congrats on your success! Beth