I Was Denied

Hi, Do you have ANY personal records of trying to lose weight? I often track my weight on my calendar, and also if I was trying to stick to a diet or exercise plan would have a journal log. I was able to create a list of things I have tried (and not succeeded at) over the years. Have you done Weigh****chers?, Atkins, low-fat, low etc....calorie restricted? That kinds of stuff should be sent in the letter. Also if you can't find weight logs, perhaps you have pictures over time to show the excess weight? I really think you need to appeal this & get better documentation. I could dig out the letter my PCP sent to the insurance company on my behlf. I was approved first go round. E-amil me at [email protected] and I will take a picture of it and email it to you... Good luck!!! Bernadette

Hello, everyone! I received a letter from my insurance company (Horizon BCBS PPO, my insurance and not my husband's), and explained why my surgery wasn't deemed necessary. Like I figured, it had to do with me not being on a supervised weight loss program. It's funny how I have comorbidities that would make me eligible but because I have no record of being on a supervised diet, they won't pay for my surgery.  Nereida

All is not lost...  Your surgery  will happen....First thing get on a supervised diet .Call your surgeons office to find out what your insurance company will accept so that you don't waste time or money. Your day will come Just don't give up

nereida don't worry about the supervised diet -- it's no big deal --but you do have do it if the insurance company asks for it -- you will have to go to your PCP once a month for 6 months or  however long they want the supervised diet for -- your PCP will keep track of your weight and say you are on a 1800 or 1200 calorie diet -- he only has to track your weight -- do not think you are failing if you do not lose weight -- it's more about being on the dr supervised diet than losing the weight -- i gained and loss weight on my 6 month diet -- you really just have to follow the insurance company rules and regulations -- i'm suprised that the surgeon's office didn't say anything when you first started going to the surgeon -- our surgeon gave a sheet of paper with everything that the insurance company expected of us before they even started with any other testing -- had to have certain things out of the way so that there was no way we could be denied  good luck to you :)  roberta

I have BCBS PPO and had to do the same thing (supervised dieting) but I followed all my doc's guidelines.  And my approval came thru 2 weeks after submission.  Do the six month dieting with your doc, write down all your diet history, write down your comorbidities, also get your doc to write down your weight for the past 5 years (one entry for each year).  Oh and get your primary doc to write a letter stating that he deems it medically necessary for you to have surgery since other attempts at losing weight have failed.  Once you get all this together, have your doc appeal the denial with all this info and you should be good to go!  Oh and you must have a BMI over 40.  For me, I thought six months was a world away, but it flew by in no time at all.   I wish you all the best! Julia