DENIED AFTER 1ST LETTER

I saw nutrionist, gi, pulmonary, pysch and cardiologist and I got denied because I didnt do a 6 month supervised diet plan with pcp, anyone know how to bypass this or have a sample of an appeal letter?

There is know easy way to bypass this, best way to do it is to see if your PCP will Lie for you, mine did. I only seen him once in 6 months, he thought it was gay for me to see him every month just to way me in he just told me to call my weight in every month, But beside see if he'ed lie for you theer isn't any way around it

Stephanie: You are right, more and more insurance companies are requiring a 6 month documented preop wt loss attempt. I hope more people will research insurance requirements when they start this process (even before they pick a surgeon!) so as to avoid this 'suprise' at what they thought was the end of the road! BUT ....*I* would neither ask my health care provider to commit insurance fraud or as a provider commit insurance fraud, regardless of my opinions on the insurance requirement. Some feel it is a tactic of INS CO. to disuade one from having WLS, perhaps, but I know NOTHING would stop me once I made my educated/informed decision. If it meant 6 months of waiting, then I'd develop a plan (acceptance after some dissapointment and frustration for sure), actually try and utilize the time to change my dietary/lifestyle habits (we have to postop anyways) and lose some weight! It can only serve us well. I would also reframe this as an opportunity to learn even more about WLS, the committment etc. Education is powerful. I am not disagreeing that this 'sucks' or is frustrating, I am saying use it to the most positive advantage as possible. Many don't even try to lose in the 6 months, I will say some ins companies may deny if you dont lose, saying you can not commit to the lifestyle after. They do not expect great results, but they are looking for an effort.... Most people who are thinking of having WLS are researching it or in the process 2 yrs....I went from starting my process in May 2002 and surgery was October 2002, almost 6 months... What you do with this challenge is up to you, how you frame it is up to you, using it to your benefit is up to you!. Some decide to pay out of pocket, but most people I know don't carry 25-50K on them, Many of us have dieted our whole life and feel why one more time? Well many fall into a last supper syndrome postop, eating all they can as the last supper , gain wt, add fat to the live making surgery even more difficult/risky. The less u have to lose the closer to an ideal BMI you will get, I wish you well..... Take Care, Jamie Lap RNY 10/9/02 Dr. Singh 320/163 5'9'' (lost 45# before surgery) Plastics 6/9/04 & 11/11/2005 Dr. King http://www.obesityhelp.com/morbidobesity/members/profile.php?N=c1132518510 "Being happy doesn't mean everything's perfect, it just means you've decided to see beyond the imperfections!"

S: You asked if you lose wt will insurance company then deny surgery? I was told by my surgeon (I had a 10% preop wt loss requirement) that that was simply not true, they are looking for the motivation, ability to adhere to a plan to know your a good candidate. Even if losing wt puts your BMI below 40, they go by the HIGHEST documented wt. WT LOSS BEFORE SURGERY/MOTIVATION/AVOIDING THE LAST SUPPER SYNDROME In our program we are required to loose 10% of our body wt before surgery.... Loosing weight pre-op is required by many surgeons & for many reasons... and I am so happy I did! 1.. to show motivation, 2.. ability to adhere to a plan (as we will need to for life!), if you can't be mindful and able to follow restrictions pre-op how will you do it post-op? 3.. to increase your health even a modest 5-10% wt. loss is very helpful, the National Institute of health has even researched this...(hence why weigh****chers is so focused on the 10% wt loss) 4.. decreases surgical complications (by exercise and decrease wt your heart and lungs are in better shape for surgery, anesthesia and healing!)... 5.. Also psychologically it is tough going from a super-sized big Mac meal to clear liquids for 2 weeks post-op! 6.. ***MAIN ONE FOR PROTEIN SPARING or MEDIFAST DIETING***It helps shrink the liver and this eases their surgical procedure and decreases chance of nicking it.... 7.. exercising before helps you continue after! 8..The more you lose pre-op the less you will have to lose post-op and the closer to an ideal body-wt you will attain! I lost the weight by doing the food pyramid. That's it, I was eating so bad (fast food daily, large portions, consuming every high-fat/sugar thing imaginable and NOT exercising that just cutting down and walking 2 miles a day helped! For ME, it was "no one" was going to stop me from having this operation, it was my decision and all that was asked of me was to loose 30 lbs, I figured this is a small price for such a wonderful gift I would be given and the opportunity to have a healthier happier longer life....! I was so motivated/psyched; I dropped 30 pounds in 30 days and went on to drop 15 more before surgery! (Although this took me 2 months, as it got harder and I had a few last meals, we all do but you can't let this ruin your opportunity!) Exercise was another key; I faithfully walked 2 miles everyday..it helped that my mom went with me a lot! (a buddy is so helpful!) I followed the food pyramid given to me by clinical nutritionist Dr. Boham...I also wrote everything down (Many find www.fitday.com helpful for this) that went in my MOUTH!!! Or you can get food pyramid/bullseye version at: http://www.xenical.com/hcp/1400_Am_Beye.pdf I also had to remind myself how BAD I wanted this! Everyday it was/had to be more important to me to change my bad habits and lose weight to have this surgery than to continue to slowly kill myself with food/keep myself from the only hope I had!. I also told everyone about my plans and they helped support me, my friends/family and coworkers! I really can't give you any more guidance than this, it really had to come from within, it was a mindset with me, and I wanted this BAD real bad and I knew it was my last resort/chance! I felt invigorated and motivated by the end results...the long-term had to outweigh the short-term gratification of eating bad choices or overeating! It was a learning opportunity for me to change my habits and practice chewing well, not drinking with meals and eating smaller portions, giving up sugar/caffeine/carbonation/alcohol (if any of those are your issues, carbonation/caffeine/alcohol weren't issues for me)! So a few weeks/months of healthy habits to lose pre-op wt is not a lot if you frame it right! IT IS NOT FOREVER and it is about starting this journey! Take Care, Jamie Lap RNY 10/9/02 Dr. Singh 320/163 5'9'' (lost 45# before surgery) Plastics 6/9/04 & 11/11/2005 Dr. King http://www.obesityhelp.com/morbidobesity/members/profile.php?N=c1132518510 "Being happy doesn't mean everything's perfect, it just means you've decided to see beyond the imperfections!"

generally there is no way around this unless you have a doctor who will say that you have been on a supervised doctor. i had this same problem but then i remembered i had seen a two diet doctor within the time my insurance company allowed. i called both of them and they wrote letters on my behalf saying i had been on a supervised diet plan. instead of trying to get around this, i would suggest to go to your pcp or a diet doctor and start a supervised diet. personally, i wouldn't actually follow the diet, you don't want t ogo below the required weight, at least this way you have proof you tried a supervised diet. good luck, donna