Question:
Any Suggestions on what to do next denied referral?

I have Blue Cross PPO/Plus my IPA is Physician's Associates - PA has denied my referral for consultation with a gastric bypass surgeon. There reasoning was i didn't have a current 6 month medically supervised diet on record. I had gone through Lindora in 1998/1999 and subsequently gained all 100lbs I had lost. They have sent me to a Doctor in order to start yet another diet program. Should I go ahead and waste 6months trying to diet or appeal. I'm 5'1" and weigh 310 lbs been over weight all my life. Thank you    — pespinosa (posted on March 15, 2005)

March 15, 2005
Yes you should go through the 6 months of dieting - it isn't a waste. If you don't, then it will be something else the insurance company will use to deny you. You can start the 6 months and get the referral during that period. I also advise sitting down and writing a chart of all weights for as long as you can remember. Also see if you kept any paperwork, etc. from any diets you tried on your own or that were supervised. All of this documentation is helpful when it comes to winning the approval process. Hang in there and keep on keeping on.
   — Wassupwu

March 16, 2005
I'm not sure but with BCBS/PPO you shouldn't need a refural. I have BCBS/PPO and didn't need one. I will also say that you should start the 6 month diet with the Dr. it will take you that long to get through all the appointments and waiting that goes with WLS. Good Luck
   — Peggy R.

March 16, 2005
Yes, you should definately start the 6 months. I am in the same boat, 4'11" and 305#. I was denied nd started the 6 month diet. I am also appealing, but it seems like my 6 months will be up before I get all the way to a review by the state insurance board. Two more months and I have my proof.
   — Sharyn