Question:
Has anyone else been denied because no medically supervised diet in past 12 months?

I was denied by Highmark Blue Cross Blue Shield because I have not been on a medically supervised diet in the past 12 months. I have provided proof of medically supervised diets in the past -- Fen/Phen as well as a Very Low Calorie/Fasting-type diet -- put the last was in 1999-2000. I've since been on other diets. I live in Kentucky. My BMI is 41.2. I submitted letters of support from two doctors. I underwent and provided documentation on psychological examination and nutritional examination -- both supportive of the surgery. Yet still I was denied. It's so frustrating. Please share your experience, particularly whether you were ever able to get approval.    — dotyel (posted on March 18, 2003)

March 18, 2003
Yes Elenor my sister has Etna and they made this rule up as they went along. She's fighting it because she sent her info in before they made the stipulation that you have to have 6 months with a doctor supervised dietician. Think about it, are they so stupid to think that we haven't dieted in our lives, or know nothing about nutrition? Most of us have done anything and everything. I think each person should be evaluated by what they've done in the past, i.e. your other doctor supervised diets. It's ironic that they will pay for my sister to see this nutritionist and then in 6 months pay for her surgery. But the way her BMI is over 50. And her insurance company without compassion basically told her so what that they saw people with that high of a BMI everyday. So I hear where you're coming from and I can only suggest either you appeal or stay the course, follow the diet the prescibe and you'll be lighter going into surgery. I'll pray for you. Btw my BMI is 40 something and after supplying my insurance with the MMPI and other information I was approved, but it took months. I guess we should be thankful we at least have insurance that although have stipulations, at least cover it. Just stay positive and don't let them get you down. I hope and pray that you have a good support system. Good luck!
   — cat F.

March 18, 2003
I am now in the process of beginning to seek approval from my insurance company. I also have Highmark Blue Cross Blue Shield. Luckily, when I called my surgeons office to schedule a consult I was informed about the policies of BCBS and went immediately to my PCP to begin a medically supervised diet. The only answer may just be to start the medically supervised diet ASAP and while doing that make sure that all your other "ducks are in a row." I have heard though, that at times WeightWatchers or Jenny Craig or some other type of structured weightloss program will satisfy an insurance company as far as "medically supervised." Good luck and I will keep you in my prayers.
   — Rhonda Y.

March 18, 2003
I was denied by BCBS of Florida on 01/29/03 b/c I did not have 12 mth of supervised dieting by my pcp. I immediately had Walter Linstrom appeal it for me and I got approved on 03/10/03. So yes it can be done. It was worth every penny!!!!!!!!!!!
   — lalulan

March 18, 2003
I too am having insurance problems. Our policy runs from July to end of June. Last July 2 I called and got guidelines that had to be met before having the surgery. They told me at this time I needed three documented physician supervised diets of at least three months each, one being in the last year. I Dec I went to PCP to start diet. Three months up March 3. Now insurance is saying you need three diets of six months one in the last year. I call today and told them policy could not change until July 1, 2003 and that I had spoke to Stacy on July 2, 2002 and she gave me the guidelines for the year and that they could not change them now. She agreed and told me to go ahead and have physician send paperwork to insurance. I did just that but I am still preparing for a fight. We will see. Just don't give up because that is what they want us to do. I know it is hard but I just keep thinking it will all be worth it in the end. Good Luck
   — D. Bell

March 19, 2003
I was denied by my insurance (Anthem BC/BS)because I did not have 18 consecutive months documented weight loss efforts. They said the documentation I had was not good enough because it did not chart my exact weight. I was too large for the doctor's scale. I got fed up and decided to fight it. I looked into hiring Walter, but I called my insurance first. They told me there were other steps I had to go through before an attorney could get involved. Anyway, I went through their appeals process with every intent to hire a lawyer if I was denied again. My surgery was approved through the appeals department. I went into greater detail in my profile page. Don't quit fighting! Some insurance companies will do anything to drag this out in hopes that you will give up. Don't let them win.
   — Jenny S.