Question:
Does Intracorp *always* require proof of medically supervised weight loss attempts?

My employer (Gallagher Bassett Services) is self-insured and self-administered, but they use Intracorp to determine medical necessity. I just got a letter from my insurance today advising me that my pre-determination request for BPD/DS has been forwarded to Intracorp for medical necessity review. I'd heard that Intracorp requires at least one and sometimes two 26-week-long medically supervised weight loss attempts before they'll deem WLS medically necessary. This scares me, because I don't have that-- didn't see the point, seeing as dieting all my life got me where I am today, with a BMI of 56! The info I could find here about Intracorp was a bit confusing... it appears that their requirement vary. Have others found this true? I'm hoping that this is the case, especially since my employer is self-insured and I *was* told when I initially inquired that they went by the surgeon's recommendations to determine authorization. They didn't tell me, though, that Intracorp would have any role in determining medical necessity. I suppose if I'm denied I could hire Walter Lindstrom! Any info that any of you could share about experiences with Intracorp is appreciated.    — liannenc (posted on December 14, 2003)

December 14, 2003
Talk to my cousin, Lisa Nye on this site. She fought them w/ Walter Lindstrom and won. Good luck!!!
   — Fixnmyself

December 14, 2003
I had the same problem with my insurance. I have GHI (Medical) Empire Blue Cross Blue Shield (Hospital) BC/BS uses Intracorp to make their decision. GHI said they would pay my surgeon but BC/BS wouldn't pay for the hospital stay b/c I didn't diet for 6 months. I had submitted a 15 yr diet history and it still didn't help. I hired Walter and Kelley Lindstrom to handle my appeal and 3 days after a letter of representation was sent out, I was approved. Their website is Obesitylaw.com. If you have any questions please don't heaistate to ask.
   — Lisa N.

December 14, 2003
Thank you both for your response... I've been trying to email Lisa through the website all day with no luck. Obesityhelp's server isn't working :-(. Lisa, if you happen to see this would you mind contacting me directly? My email is [email protected] Thanks so much!
   — liannenc

December 15, 2003
I have Cigna PPo and they too use Intracorp. From what I understand, Intracorp is hired to maintain the claims using your insurance's guidelines to determine eligibility. My insurance required a 26 week medically supervised diet. I provided it and was still denied. Intracorp told me the letters (3) that my doctor submitted, although verified and provided dated weigh-ins was not sufficient but wouldn't say why. I was denied twice and then my doctor called and spoke with a doctor on their medical review board and they approved me at once. I would suggest asking your doctor to do that for your first. I'm sure you've discussed your weight loss struggle with your doctor at one point or another. Good luck.
   — boonikki29

December 15, 2003
i do not have that insurance, however, i had to prove 18 months of weight los attempts with bcbs out of north dakota. i think most ppl have to prove some methods that did not work. if you feel you are being violated or done wrong, then attempt legal action, but until then, i would just suggest doing what is mandatory and see what happens. best of luck.
   — Markita M.

January 10, 2004
**UPDATE** Intracorp used my employer's guidelines to determine medical necessity (I imagine they have to since my employer contracted with them for this service). They required that I obtain a second opinion from another surgeon (paid by my insurance at 100%). Once Intracorp had the second surgeon's report, they approved my surgery.
   — liannenc