Question:
Has anyone experienced denial because insurance says you haven't been MO long enough?

Unfortuanately for me, I received a denial letter from my insurance saying that I don't meet the requirements for being MO for 3 years or longer. They say that my highest weight to put my BMI at 40 or greater was in August of 2004. Does this mean that I have to wait until 2007 to have surgery? Or will August 2006 make 3 years.....2004,2005 and 2006? They also say I need the 6 month supervised diet,which would put me past August. Anyone have ANY suggestions for me? I would greatly appreciate anyones thoughts and or prayers. Thank you so much. Tracy    — Tracy LeAnn (posted on May 5, 2006)

May 5, 2006
sorry about your issues. you can appeal to the insurance com. and you can also get a obesity attorney. they run about 1000-1500. you need to find out exactly what u are missing. right now the insurance comp. are making it really hard to get wls. some ask for 6 months, 12 months and now even 18 months of a diet through your pcp. that is about all i can recomend right now. i am sure others will have suggestions. good luck Steve
   — Steve Cohen

May 5, 2006
Bor do I know where you are coming from. Hang in there, if you need to wait a while it will be worth the wait. I am 3 months into my 6 months of supervised diet and I am learning alot about the changes I have made and some I will be making after surgery. Try to think of it as time to educate yourself more, that's what it helping me. After 7 years my ins. is just now covering it under thier policy.
   — Tanya1992

May 5, 2006
Although my insurance is a PPO, they still require the 6 months supervised diet and exercise program. I have been on prescription appetite suppressan, since Dec. 23rd. My BMI is down to about 45, when I started it was 47. Unfortunately, between completing my college coursework in order to graduate this May and working 40 hours a week, exercising has taken a back seat and yet I still continue to lose the weight. My doctor wants me to give it a good effort in the exercise department to show her that I'm committed to the program before surgery so she will be convinced that I'll be committed to the program after surgery. My insurance is with a PPO and I really don't need a referral from her to have the surgery. This coming Wednesday, I will be attending the seminar at Greater Baltimore Medical Center. You have to attend one of these prior to being seen by the doctor --this I knew already. Ask to see the letter that was written by the Doctor to the insurance company. That may give you sojme answers right there as to why you were denied. A lot of times, it's all in how the letter was written and whether or not the physician stressed "medically necessary." If you still have to wait, may I suggest that next time it's open enrollment at your place of employment, opt for the PPO.
   — the7thdean

May 7, 2006
Well if you are counting from August 2004, yes you have to wait till lAugust 2007. You don't count the year 2004, just 2005, 2006, and then 2007 would be 3 years. Do what you can beforehand, listen to your PCP for nowq, and try to be patient. I know it is so hard, but really try.
   — KRWaters

May 8, 2006
Have you been overweight a long time? I only met 2 of the 4 years required by BCBS PPO. I took diet pills for 2 years and lost 100lbs.. when I stopped I gained the weight back. I have been overweight since I was in middle school. I had to appeal 3 times but was approved. There is more than just BMI involved. The insurance company should have sent you a detailed letter explaining what they require. Usually if you have co-morbities the BMI requirement drops. Hope this helps!
   — Jennifer K.