2bfit

You have to accept whatever comes and the only important thing is that you meet it with courage and with the best that you have to give. - Eleanor Roosevelt

Highest weight 265 lbs
Initial Visit 234 lbs
Current Weight 229
Goal Weight 145

First PCP Visit 7-20-11
First Denial 7-29-11 Not medically necessary BMI 39 & no qualifying co-morbidities
Appealed and denied again 8-31-11
Second PCP Visit 9-2-11 gained weight BMI 41
Denied 9-14-11 Needed to show motivated attempts at weight loss. Submitted my medically supervised weight loss records, gym membership and HCG diet receipts.
Approved to see the surgeon and dietician 9-15-11
Nutrition appt 10-3-11
Surgeon consult 10-4-11
Surgery Denied 10-7-11 need to have one qualifying comorbidity with a BMI of 35>(they are not referencing my evidence of coverage or what my plan covers. Instead they are using a Medicare plans guidelines), need to meet with Nut for 3 addl visits and enroll in their weight loss program.
Appealed 10-10-11 submitted medically supervised weight loss program records for 2 years, with 5 year gym membership and the HCG diet. Informed them I already met with the NUT. Went ahead and also scheduled with their weight loss program just in case. Also included the 2 letters I had from the medical group and UHC which outlined what MY plan covers, not the Medicare plans!
On 10-12-11 I met with the weight mgmt program through the medical group. They want to put me on Medifast. I had an appt immediately after with the NUT who is adamant that I do not do the Medifast program because she knows it will not work for me. She said she would document her chart. I meet with her again on 11-2-11.
10-14-11 Resubmitted my appeal to the correct case manager
10-17-11 Made sure my PCP and surgeon faxed over their consult notes to prove medical necessity
10-18-11 Checked with the case manager to make sure the ppw was recd (i think she is irritated with me already oh well!)

Surgery approved on appeal

Surgery date 12/28/2011