Can you provide some info to help with my appeal???
Hi all. I am getting my appeal ready. But I am hoping to gather some info first. If you don't mind sharing, I am needing, specifically, what insurance you have and how long was your medically supervised weight loss requirement. For example: Amerigroup (Nevada Medicaid), 3 yrs.
I am finding that most insurance copies require 6 months. Mine is 3 years. Yikes. So I wanted to include that data along with all the other info I have. Thank you so much...I greatly appreciate it.
I am finding that most insurance copies require 6 months. Mine is 3 years. Yikes. So I wanted to include that data along with all the other info I have. Thank you so much...I greatly appreciate it.
RNY on 03/26/12
There is another WLS board where I believe people may be able to help you. I can't remember the name but it has the words pro board in the address. Hopefully someone will come along with more info.
Check the wording again-- do they require 3 years of medically supervised weight loss, or three years of documentation of being obese?
I have BCBS Anthem, and needed to provide three years of medical records documenting that I was obese. Anthem did not require any medically supervised weight loss program, but my surgeon required three months worth of dietician meetings- so I met with the dietician once a month for three months.
I have BCBS Anthem, and needed to provide three years of medical records documenting that I was obese. Anthem did not require any medically supervised weight loss program, but my surgeon required three months worth of dietician meetings- so I met with the dietician once a month for three months.
This is where it gets tricky. The member handbook does not state either one. This is the info that has been given to my surgeon by the medical management team at the insurance company. And every time I have called, they have not disclosed this to me. They tell me the BMI requirements, age requirements, and waist circumfrance requirements...and that's it. That is why I should get approved with my appeal.
If your surgeon is saying 3 years but your insurance(medicaid) which is the tuffest, is not then maybe I would dig more into the surgeons office. Maybe because of medicaid they don't want to operate on you. Sorry to say this is known to happen. Maybe get a 2nd opinion with another bariatric surgeon.
BCBC eliminated their requirement for preop supervised diet 2/1/12. Medicare/Medicaid usually follows within a year. So, they are not there yet, but I would think that the "6 month" standard would be the norm. I would dig, dig, dig, question, question, question!
BCBC eliminated their requirement for preop supervised diet 2/1/12. Medicare/Medicaid usually follows within a year. So, they are not there yet, but I would think that the "6 month" standard would be the norm. I would dig, dig, dig, question, question, question!