Question:
Did anyone have they insurance company to tell their Primary Care doctor that in

order for them to aprove for the gastric bypass surgery, that the patient needed to be on a low fat diet with exercise for a year. The reason I asked is because that's what happened to me today when I went for my physical. Said that they needed some written documentation of me trying to lose weight and exercising. I mean really, I've tried that all my life and it did not work. If I'm considering this surgery, that obviously means I can't do it on my own right? Can someone answer me, because I'm feeling just a little bit low now. I'm going to definitely research this more.    — blank first name B. (posted on May 16, 2002)

May 16, 2002
I think most of us had to document our previous weight loss attempts, and they wanted them to be medically supervised, or at least supervised in some way. Did you ever go to Weight Watchers? Write it down, how much you lost, and how much you gained back. Ever do Nutrisystem? Write it down, and so forth. That should help you in gaining approval. Good luck!
   — GGinMA

May 16, 2002
This is one of the most common reasons that Blue Cross/Blue Shield give denials on. That you don't have 1 year of Dr. Monitored weight loss attempts. That Is what they told me despite like you, I have dieted almost my entire life. So I hired Walter Linstrom at obesitylaw.com. In my 28 page appeal letter, one of the things he points out is that it is illegal and discriminatory for them to require you to go through a treatment that they exclude, (no insurance companies pay for medical supervised diet), in order to qualify for a medical treatment. Also they can't place requirements that are not part of the prevailing generally accepted medical practice. The generally accepted medical practise is established by the NIH (National Institutes of Health) and is only that you have failed at dietary attempts. If you have dieted at all and failed, that qualifies under NIH guidelines for WLS. I would fight them on this, and especially if you have any serious co-morbidities, you should be able to win. Good Luck.
   — Dell H.

May 16, 2002
I believe most ins. plans ask for proof of WL failure. They want to know that you aren't just someone who gained a bunch of weight and is looking for some easy way out. It is a major surgery and can be hard on your body. Have you ever taken diet pills? Used a personal trainer? When to Weight Watchers/ Jenny C? These are the kind of things they want to see. If you've been overweight all your life, I'm sure you've tried programs that your not even thinking about. But the records are still there. You've just got to get them. Also, type up the diets you've tried on your own and send those too. Well, I hope this helps. Good Luck to you!
   — Sarah K.