Ugh.. Insurance woes, any coments help

Hello again all, finally met with the surgeon who i want to do with my operation, He gave me a list of tests to get done and that good in all but... I have Empire BC/BS, I called them right before making my surgeon appointment (3 weeks ago), They told me all they needed was a letter of necessity (same thing needed for my past non WLS operations). At the doctors office (i was there with many others) some one came out and gave an announcement that EMPIRE, as of now demand 6 consecutive months of medical records are required for approval. I asked there medical doctor when it was my turn to see her, and she said that it isnt as strict as it sounds...still i worry, so i get an appointment with my medical doctor to see if i can get thoes medical records... He looks though my chart and sais he dosnt have 6 months, and even said that "who goes to the doc once a month" and "even if we started now by the time 6 months comes around the policy will just change. He has over 15 years of records on me with weight issues and said he would do whatever he could to help me but i feel like im screwed... Anyone know if this six months policy can be worked around? or am i truly screwed? Cuz right now I seems like doing all the testing would be a wast of time and money

Michael- I think you might be confusing what you need, normally you need a letter of medical necessity from your pcp, which is an easy thing to get, just have your doctor write a letter saying he recommends that you have wls because your weight is effecting your health. In addition to this, your insurance company probably requires that you show 6 months of consecutive dieting (medically supervised). How you show this..... it depends i've seen some people post that their PCP wrote a letter saying they have been dieting for 6 months and they didn'y lose any weight .... even though they haven't. this is a gray area because technically your doctor shouldn't do this, if he hasn't had you on a supervise diet for 6 months. Bottom line your doctor can get in major trouble if says this and it isn't true. Do you have any documentation of your attempts to lose weight, some insurance company will accept programs like weigh****chers and jenny craig? I had this same problem....then I remembered I had seen two " diet doctors" on and off for roughly just over 6 months. I had both of theses doctors write a letter stating that they had me on a medically supervised diet and for how long, Aetna approved me with this proof. Best bet is go see a dietician for 6 months, unless your PCP is willing to say you have been on a diet for 6 months your insurance company won't approve you for wls. There's no way around this. I hope I help you a little....good Luck Donna

-i am kind of in the same boat i also applied and was not told about a 6 month suppervised diet plan until after i got my first denial letter so i appealed it 2x and got a second denial letter so in the mean time i went to my pcp and said put me on a 6 month diet plan i need it for approval for my wls surgery so i am approaching my 1st month next week i go for my 1st weigh in and in 5 month ill resubmit it all again. at first i was sooo upset but now that time past i understand my insurance says they just want to make sure i can adhere to the diet plan after surgery and if i diet for 6 months because i cant stick to a diet how will i lose weight and diet after surgery. some people over eat after the surgery and get sick and throw up and even gain weight, im gettin the surgery because i dont want to be overweight anymore!! -i did all my tests and saw all docs already however the paperwork with my insurance is good for one year so i wont have to do it again only bloodwork-however if i was you i would try, see all docs, do bloodwork and paperwork and try to see if you will get approved you never know and in the process start the 6 month diet know while you are getting all the info together so you dont waste anytime and besides if you get denied you can appeal dont give up thats what the insurance wants you to do good luck-stephanie

Michael, I do not know about Empire BC/BS but with GHI I had to go to the Dr for 6 months, weighing in once a month and see a nutrionist as well. After the 6 month they both wrote a letter to the Ins Comp. What a waste of everyones time but that is what GHI needed, the 6 months of diet notes! I would confirm with the Ins Comp or your surgeon is that what they require so you know right from the start. It stunk that I had to delay my surgery for 6 months for that but we all have to fight some battle to get through this. I know others that have hired a lawyer to get around that and it works but then you have to pay your lawyer all that money. I wish you all the best hun! Keep us posted. Debra P

I have to do the same thing for my insurance...6 months of supervised dieting. I am only on my first month. Actually, the surgeon I want to go to requires the same thing. The way I look at it, it's only 6 months...not a lifetime. We have to do whatever it takes to get what we need to get healthy. I don't have a problem with the six months, I'm having trouble controlling an uncontrollable appetite. Celebrate your lifestyle! Rachelle

You are lucky all you have to do is the 6 months .. I have bc/bs of Illinois and they require 12 months .. i was denied twice and started the 12 month diet in January of this year.. Good luck and hope it goes bye fast.. Have a Wonderful day.. Kimberly

Hello Kim I also have Blue Cross Blue Shield of Illinois. Is there anything you can recommend for me? I have my first consultation on Apil 24 I am really excited but at the same time a bit worried. Did they tell you why they denied you or what the process has been like. Thank you so much. Oh by the way where in New York are you? I am in the Bronx. Lots of love Liliana

here is the we site for what they want.. www.medicalpolicy.hcsc.net/medpolicies/disclaimer#hlink .. i hope this helps i'm having a hard time with them they are the toughest to get approval through... good luck Kimberly