Question:
Will anything else be required by the insurance company if they didn't mention it?

My insurance company (Great West) denied me. They said they need a 6 month Dr. supervised diet. I am doing that now. What are the chances that when the diet is complete and I re-apply that they come up with some other "requirements?" I am trying to not get my hopes up......just in case, but it is hard not to.    — lasias (posted on January 18, 2006)

January 18, 2006
The best thing to do is to contact the Medical Management (aka Medical Review or Quality Management department) at the insurance company and ask them to email or mail their criteria for bariatric surgery to you. That way you have it in writing and have a basis for a future appeal if needed if you have met all of their criteria. Good Luck - Cheryl
   — classite

January 18, 2006
Addendum to above - I have Great West insurance in Washington State and have already had them email me their requirements. If you would like them, email me @ [email protected] and I will email them back to you!
   — classite

January 18, 2006
Hi I don't have your insurance but mine did the same thing (BCBS-TRS). After my six month I re-submitted my request along with a letter of appeal naming all my medical history, cost of my meds. and how my weight affected my life and my work. They ok'ed my request in two weeks. This is the best thing that I have ever done for myself. Don't give up. Laural HW- 313 SW-292 PW-211 GW-135
   — Laural D.

January 19, 2006
I also have Great West and was also denied after first submitting my paperwork. I received my denial letter which included the reasons why they denied me and what i still needed to submit. I also called my case manager, who was assigned to me, and I asked her for the complete gastric bypass surgery requirements; it was 10 pages. So be sure to call your case manager, their name and number will be on the denial letter, and specifically ask for the complete requirements. I also had to take six months and complete a lot of things insurance wanted. Even though i've joined weight watchers at least 15 times, i never kept my paperwork/weighin book. So i did weight watchers again for 6 months; i also went to my pcp once a month for six months straight for checkups to follow my weightloss. I had my pcp document in my chart that i am attending weight watchers, and she would take all my vitals, and weight. It is expensive to see the doctor that frequently, and do weight watchers, but it's worth it to get approved. There are a lot of other requirements and i can't type them all. Anyway, after six months i submitted a bunch of more documentation for my appeal, and i got APPROVED! It's really hard to wait six months to do all of these things for insurance. The last 2 months i felt like quiting everything and forget about appealing, but i had spent too much of my time, my money, and i really wanted the surgery. So try and be patient with the process and i'm sure you will get approved when you appeal. Good luck and let us know how things go. Take care
   — 757728

January 20, 2006
I was going to suggest you either find your insurance company's clinical rules on line at their website, or ask them by phone to mail you a copy. that way you will know exactly what to do and they can't change it on you.
   — Novashannon