letter I used (adapted from nans) I also attached copies of the phyicians notes I referenced etc   RE:      Maria DOB: 10/09   Employer Name:  Employer Acct No: Group Number:               To Whom It May Concern:   I am writing this letter to appeal your decision for denying my medically needed weight loss surgery. My height is 5’4" and my weight is 355 lbs. I have a BMI of 60. As my diet history shows, diet and exercise have helped, but as long term permanent weight loss I feel that weight loss surgery is my only solution. I have researched and learned about weight loss surgery and have worked with my physician and dietician to decide which is the best solution for me. I know there are risks involved with the surgery, but I believe that the risks of being morbidly obese outweigh the risks of surgery.   I am 38 years old and have been overweight since I was about 8 years old. I have been on diets my entire life, having some successes, but would always gain the weight I had lost back, plus more! I will list the diets I have been on throughout my life.   ·                                 Weigh****chers ·                                 Quick Weight Loss ·                                 Physicians Weight Loss ·                                 Diet Center ·                                 Jenny Craig ·                                 Cabbage soup diet ·                                 Mayo Clinic Diet ·                                 Phentermine, under a medical doctor’s care ·                                 Slim Fast ·                                 Bally’s Fitness Center ·                                 Protein Power ·                                 6 Week Body Make-over Diet ·                                 Weigh Down Workshop ·                                 First Place for Health System ·                                 Herbalife Herbal Supplement ·                                 Dexitrim ·                                 Lemonade Cleansing Diet       Currently, I am being monitored by my doctor, being weighed in once a month. I am also seeing a dietician, and working on exercises that I can do with my bad knees such as light yoga and water waling at both The Park Forest Aqua Center and LA Fitness. I began seeing my physician on March 24, 2010 in order to meet the requirements of Aetna’s 6 month physician monitored weight loss program. In addition to my doctor, I saw their in house dietician and am working with a LCSW to address behavior modification issues. I have also joined various local support groups in order to supplement my weight loss journey.   Along with my BMI being 60, I have co-morbid diseases, such as Poly cystic ovarian syndrome (PCOS), sleep apnea, high cholesterol, and pain in my joints, knees and lower legs, GERD as well as lower extremity edema. My family has a history of cancer (mother and father), heart disease (father).  I feel that being morbidly obese puts a strain on everything that I do and also affects my personal hygiene. I cannot walk very far without becoming out of breath. I have a hard time walking up and down stairs because I am out of breath and it hurts my knees. I have a hard time putting on my socks and shoes. I feel I can not live a normal life because I have a hard time fitting in small seats such as on an airplane, in a movie theater, at the ball park, or in a restaurant. I am embarrassed of what I look like, but more importantly, I fear for my health. I want to be around for my family and I feel that my weight is hurting my health. I lack self confidence and feel I am not functioning to my full potential. I want to be more active and be able to do the things normal sized people do.   If you look at my paperwork submitted, you will see that I have met the requirements for qualifying for weight loss surgery as spelled out in the Clinical Policy Bulletin 0157.  *I have had the presence of severe obesity that has persisted for at least the last 8 years *I am over the age of 18, and I have attempted many, many weight loss regimens in the past without long term success *I have a BMI of 60, along with co-morbidities *Lastly, I have completed the process of the 6 month physician supervised weight loss program.  I did this by visiting my physician, visiting the dietician, seeing an LCSW for behavior modification , all which has been documented in the following paperwork. The duration of this program was a full six months, actually 187 days, or 26 weeks, 5 days.   I know this surgery will be a life saver for me. Please reconsider your decision, as I have met the requirements that you have asked for.   Thank you and I look forward to hearing from you soon.   Sincerely,

I personally had to stop checking up, because it was driving me nuts, and I got different answers from different people, and some of it was in correct.  So I had my surgeon's office follow up after a week.

Good luck!  I just got approved by Aetna last week!

Maria

If you are trying to get approved through insurance most require a physician supervised diet and I imagine that is what CIGNA requires.  I have Aetna.  The requirement of of 6 month physician supervised diet consisted of going to the doctor for six consecutive months, specifically for weight loss (that is what your physician shoud document in the office notes as the reason for visit).  Then, also in the office notes should include your weight, height and bmi along with all of what was discussed, such as following a 'reduced calorie eating plan', exercise, behavior modifications (example:  giving up soda) etc. 

Once those six months are completed the office visist are submitted with your paperwork as proof of a 6 month supervised weight management program. 

Hope that helps.

Nan

  Hello-

I have Aetna at my current employer and have a job interview Friday for a company that uses Summacare insurance. I am going through the process of getting RNY and should be getting surgery in Feb after I finish my 3 month required diet. 

Aetna requires a 2 year weight history....does anyone one know how long of a weight history Summa needs? 

Thanks!!!

Hi, I am trying to get some records together. Can someone (no need to put in weights or anything) post a sample of what a successful record of weight management prgram looks like. Much appreciated!