Question:
my Insurance BC/BS (choice) says I have to have 12 months of Dr. supervised diet

I have been trying to get approved for W.L.S. but my Insurance company says I HAVE TO HAVE 12 months of a Dr. supervised weight loss program. Has anyone gotten around this problem ?? I have done everything required and have MANY medical problems.This is the only thing holding me back. Any suggestions????    — Kimberly G. (posted on May 28, 2002)

May 28, 2002
The 12 month requirement SOOOO angers me. Unless you are seeing a bariatric physician, 12 months of a supervised physician diet usually involves going in once a month and stepping on the scale. Maybe, just maybe if you are lucky you'll have a couple of appointments with a dietician. There..off my soapbox. What you might try is to contact your PCP and see if he/she would consider the last years worth of visit to include supervision for losing weight. After all..I'm sure everytime you were in he/she managed to mention that you needed to lose weight and had you on the scale. It probably would help if you were attending a formal program such as weight watchers at the time. Many doctors refer their patients to things like that. Good luck!
   — cathleent

May 29, 2002
This is the most common reason for denial from many BlueCross/BlueShield plans. I too like you had been on numerous diets, had serious health problems and was frustrated by this requirement, especially since I had already been about 8 months working to get into WLS surgeon, phsych eval etc., only to find out then that they were denying me because of this. I appealed on my own on a level 1 appeal, they still denied me so I decided to hire Walter Lindstrom. According to his legal brief/appeal letter, it is illegal and discriminating for insurance companies to require this. He sent in 28 pages of legal argument that disected and ripped appart that policy from both a legal and medical standpoint. I was approved within 3 days after the insurance company recieved his appeal letter. The insurance companies are just using this as a discriminatory requirement to get out of paying for WLS. Even after completing 12 months, many get denied again for whatever reason, if they didn't loose weight, they didn't try hard enough, or if they lost any weight then they would say they don't need surgery now because they can loose weight by dieting. I would recommend to just hire Walter Lindstrom. It only cost me $350 and was worth every cent. Good Luck.
   — Dell H.