Question:
How did you approach the ridiculous requirements of your insurance?

Just spoke to my medical "group" today to find out what were the exact requirements that were needed to get a consultation with a surgen. Among other things they told me that I needed to have been on a physcians supervised medical weight loss program for 6 months out of the last 2 years and that I needed to be on Meridia and Xenical for 3 months. Did any of you run into this as well. Will they really require me to take drugs that will sure, make me loose weight for a while just to gain back more? I also don't believe that they would think that anyone who has been overweight for so long hasn't tryed EVERYTHING already. I have PacifiCare and Pro Care IPA is my group. Thanks for the input:~)    — April R. (posted on July 9, 2003)

July 8, 2003
April, if your insurance company requires you to be on Meridia of Xenical, are they paying for the script? My insurance company won't pay for diet pills. They cost around $100.00 for a months supply and they don't work. If they aren't going to pay for them or offer a discount, how can they require you to take them?
   — Debbie W.

July 8, 2003
Meridia and Xenical both have side effects. Xenical cuases an orange discharge and cramping in some patients. I already had high blood pressure so Meridia was out. My doctor wrote a note to the insurance company briefly explaining that Meridia's side effects include blood pressure spikes in some patients and he was not going to use me as an experiment. No one can require you to take any meds, but they can require a diet history.
   — M B.

July 9, 2003
I dont know if they can require it or not I just wanted to say I have been on Meridia for over two years and my insurance has been paying for it after I got a preauthorization. Now they say they will not pay for WLS because it does not cever weight loss or obesity treatment. Figure that one out! Needless to say I am doing an appeal.
   — becky M.

July 9, 2003
First, no one can require you to take meds. Besides, most obese people have medical problems that would be aggravated by the meds. You said you talked to your medical group but have you actually called your insurance yourself to find out what their requirements are? Mine also had the same crap about supervised diets, blah, blah, blah. And I felt the same wasy - we've all tried everything already! besides, why would I pay or have them pay for another program that statistics have already shown WON'T WORK! What my Primary Doc did was to give an out line of my medical history - I told him which diets I was on approximate dates, weights, etc. and he included it in his letter. Afterall, he is and has been my only medical supervision for 14 years. He worded it as strongly as possible, i.e. he watched attempt/failure one right after another, cited how some diets had aggravated or caused problems and also stated that this was the only option left. Death or possibly a catastophic medical event would take place necessitating long term highly expensive medical care should the surgery not be approved. He also stated he felt all current conditions would be greatly improved if not completely alleviated by the surgery. He also cited studies proving this. Get your "medical team" to "STEP UP TO THE PLATE" and help you with this. Remeber - they WORK FOR YOU! Good Luck!
   — Deborah F.

July 10, 2003
Just read your question, My insurance also wants patients to have used Xenical and Merida, but like the other person my Dr had refused me Merida due to my blood pressure problems, he did write me a script for the Xenical, That was not something that was going to work for me, I can not be running to the bathroom every few minutes and I am certainly not going to embarrass myself because I was not able to get there in time. Quit taking it and just told the dr that It caused too much discomfort to continue, that got me the notation I needed in my Chart. My insurance also wanted to have 6 months of dr supervised diets, I wrote out my life history and my pcp included all the diets in the letter to the Insurance company, Medical Managment has told me that the information that was provided would be sufficent and that I should have no problem once August comes around and they start approving our group. Good luck
   — LS F.