Question:
My insurance covers WLS but you have to have 18 months of dr records

I've been looking into my insurance and they are requiring 18 months of dr supv weight loss program. My dr wrote them a letter stating that he has been supv'ing me for the past 18 months and at my last appt WLS was discussed and I was referred to Dr Shina. Well He hasn't really supv my weight loss for 18 months. He has been my dr for a few years but not for 18 months of consecutive weight loss program. I get to frustrated on them to stay on one for 18 months. That is the only exclusion my insurance company has and I'm really worried they won't approve me on just this letter. If they ask for medical records it won't work. My pcp is very supportive of my decision and says he'll do whatever its gonna take to get me approved. Is there any way around this 18 month exclusion. I can just hear the insurance company denying this and then making me wait 18 months then denying it stating she can lose weight on a diet and then not allowing me to have this surgery. HELP!!!!!!    — miccimouse (posted on July 24, 2002)

July 24, 2002
If your Dr. discussed your weight and made suggestions to you for the last 18 mos. then that should be sufficient. When I got my medical records I went through them and wrote down each visit, my weight, bmi and that we discussed my diet and exercise. He concurred and sign the letter on his letterhead and I got it approved. Good luck!
   — Lora T.

July 24, 2002
I visited your profile page to see who your insurer is. I have Anthem BC/BS Blue Access Plan (it's a PPO). I sent in for pre-approval and Anthem sent me a letter asking for 18 mos weight loss history. My family doctor compiled a summary of my weight loss efforts over the last two years. Anthem reviewed that and then sent me a letter that said it wasn't good enough. They wanted office notes. The problem was they didn't exist. I had a few mentions of wl efforts in my chart, but they were few and far between. Some things I had tried on my own, other things were not properly documented. I was over 350lbs. and could not weigh on the scales at my Dr's office. My Dr. sent Anthem a letter stating they could not weigh me. Anthem basically said too bad, and suggested I find somewhere else to weigh! I did for 4 or 5 months and tried again. They sent me an official denial. I started the appeals process. Anthem sent a fax to both my surgeon & my physician. It was one page, 5 questions. They people in appeals didn't even look at my documentation. They reversed my denial. I had an approval letter less than a week after my case was turned over to appeals. I am now 2.5 weeks post-op! My message to you: Never give up hope. It will happen!
   — Jenny S.