What are they looking for - Medically supervised diet?

Hello, I really need your help. I have Highmark Anthem BC/BS (basically Highmark) and was denied after my initial submission and denied after the peer to peer review because I do not have the "clinicals" or proof in my medical records that my physician supervised my diet. I have been on Jenny Craig for over a year. My Dr. and I have talked about it on numerous occassions - she just didn't note my file! She did write me a note stating that she has supervised my weight for at least 6 months over the past two years (which is what they're looking for. A note from my Dr. with no notes in my file isn't going to work. Tons of comorbities and BMI in the approval zone - just no clinicals ARGH. My surgeon is moving to a new office and they do not have an insurance person yet. I can't ask anyone else. I don't even have a number for the new office. I did receive an email from him stating that he was initally told no but he would try again. I know he doesn't really do these though - his old insurance person did. Would it help if I contacted my insurance company and discussed / explained it? That I was on Jenny Craig and my Dr. and I discussed it - she wouldn't have written that note if we didn't. Should I go ahead and see my Family Dr. for a "medically supervised diet? " What exactly is a "medically supervised diet?" nutritionist? Medicine? Thank you so much for your help! I am so sad.

You need to get a copy of the insurance requirements for the surgery. They are not included with your policy, you have to request them specially. If you have CIGNA, I think theirs is on their website. Mine wanted physician supervised diet, including a "very low calorie diet", proof of monitored exercise, and behavioral therapy. My doctor said the medical group had something like that, but it ran $400 per month, and of course, the insurance wouldn't cover that. Not all of them are that strict, however, but you need to find out. These requirements are just another roadblock the companies put up to discourage people from the surgery. If you read the post about diet above yours, I told someone else about my experiences with this and what happened for me. I'm glad to share with anyone who can use my information.