Did you have to use an attorney to get your surgery approved??

I am just curious. My insurance denied me for "not medically neccesary". My cardiologist suggested getting an attorney just to write a letter. I am considering obesitylaw.com to help. Any feedback?? Thanks.

=[ no, I was approved right away. I had 2 surgeons as well as my primary care physitian write notes on the importance before we even submitted. I have tri-care, which is military insurance and they are excellent. I am sorry that yours got denied. =[ I hope they change it

No, I didn't, but I quite clearly met the criteria. Four comorbidies and a BMI of over 50.

I would first ask my insurance company to be more specific as to why they think it is not medically necessary so you know which front you're fighting on.

I would also look up the appeal process so you know what steps to take to have the decision overturned.

Why did they say it's not medically necessary?  Do you not meet their criteria in some way?  Or did your surgeon not provide all the necessary paperwork?

Thanks for your responses. I just got off the phone with a nurse from case management. The denial says "not medically neccesary". But she stated it was because I was not on a medically supervised program for 3 years. So...that is what I thought and what my surgeon told me in January.

Your insurance requires a three year supervised diet?  That's crazy.  But, if they do, and you did not do a three year diet, I don't see how an attorney would help.  If you don't meet their criteria, they won't pay.  I don't know if an attorny would sue them to try to change their criteria.

Three years is really crazy! I did a survey of over 100 people on this site and gastricsleeve. 1 person had 1 year..the rest were either 6 months or none. My argument is that if that is their requirement..then they need to disclose it. EVERY SINGLE TIME I called, I was told there was no other requirement besides the BMI. 1 time I was even told there was no criteria except medical necessity. Either way I am going to appeal. Thanks all for your input. Be blessed.

This might be useful to you.  It explains that there is no medical reason for the pre op supervised diet to be required by insurance companies - studies to not show it improves patient outcomes or anything like that.  s3.amazonaws.com/publicASMBS/GuidelinesStatements/PositionSt atement/ASMBS%20Position%20Statement%20on%20Preoperative%20S upervised%20Weight%20Loss%20Requirements.pdf

Thank you thank you Kelly. Have a great day!!

sometimes they dont tell the patient everything - honestly I think alot of the people that answer the phones dont know what they are doing - some are great but some are terrible. So, it depends on who you get on if you get the correct information - once I called 4 times and got 4 different people and got 4 different answers. It was crazy.

I think you are best off when you see a doctor or surgeon for the first time - they always call up the insurance company to confirm elligibilty and the surgeons office will alway know what the requirements are. YOu said in your other post that you thought that was the  reason because your surgeon told you that in January - so you have known this for the past 5 months - why havent you tried to go to all your doctors and see if you can come up with a 3 year history?  All you need is that you were weighed during the last 3 years to show that you were overweight for the past 3 years.  The people that need 6 months = that is different, they need to go once per month to there PCP and get weighed, talk about there eating and get any advise from the doctor.  They do this once per month for 6 months to show they are trying to lose weight before the surgery or atleast trying.

I have seen a few lately that got denied because they needed 5 years and she got around it by giving dates that she had been on specific diets like weigh****chers - you get weighed there, a doctors appointment , gyn, any specialist, if you went to any other diet place and got weighed - some gyms you can have a proof of weight or a nutritionist.  I had 10 years of weigh ins from a nutritionist.

but if you knew in January, why are you suprised now?