upset...insurance denied

[RitzysWeightLoss 3]

Hi..I'm so upset and frustrated. I did my 6 months supervised diet and everything...my paperwork went in first of may and insurance denied Romney the 15th. Said I didn't do a doctor supervised diet. I met with my doc...she approved and then I met with a team.nurse..nutritionist ..pt...for 6 months. My doc called and did a peer to peer review with insurance yesterday and they denied again.. my doc said I can start over...meet her and the team once a month for six months... ughhh...I can not take that much time off work again for the next 6 months. I'm really sad...I so need this....sorry for whining

I don't really understand why you have to meet with the nut team. For my doctors supervised visits, I just went in, got weighed and talked to my doctor for a few minutes. The entire visit may have lasted 5 or 6 minutes. The time waiting to see the doc was what boosted the visit to 30 minutes, easily done over a lunch hour. Also, make sure the doctor is using the correct forms, that was one of the reasons for my initial denial. They apparently couldn't accept just a written letter from my doctor, the information had to be on their forms.

[mama angela 22]

Thanks. I'm going to see if I can get time off work to restart this...maybe see if I can find a doc closer to work. Or..I might look into taking a loan...because one of the new insurance things is that if I loose any weight during that 6 month period they have the right to deny it.

[deleteme 176]

Thanks. I'm going to see if I can get time off work to restart this...maybe see if I can find a doc closer to work. Or..I might look into taking a loan...because one of the new insurance things is that if I loose any weight during that 6 month period they have the right to deny it.

That is how my insurance is. If I lost any weight it was considered a success and they would therefore not cover my lapband.

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[mama angela 22]

Did you end up paying on your own?

[HotButterFly 981]

WoW!! What I insurance companies are these??

[mama angela 22]

I have BCBS...I live in Idaho..

[deleteme 176]

I have BCBS of AZ. I did end up doing self pay.

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[deleteme 176]

I also had a hiatal hernia so my insurance covered that repair (and consequently the anesthesia for the band).

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[Karen WS 78]

I have Anthem BCBS of Michigan. My surgeon turned in all my paperwork and my PCP gave them a letter if necessity and they approved my surgery and 12 fills 3 days later. I have. BMI of 40 with 2 co morbidities. Surgery tomorrow. I would call who ever was your case worker at BCBS and find out why they denied it.

[deleteme 176]

You must also remember it has to so with negotiated benefits that the company you (or your spouse) work for set.

[mama angela 22]

I have BCBS. I'm not impressed...with how they are handling this. I could understand if I was not very much overweight...but I'm 150 pounds overweight..and have been for years...

So, my nurse at work here wants me to restart the program - go meet with the doctor, nutrionist and physical therapist...she said if I lose weight and don't need the lap band that that is great - that is the goal. I panic at that thought...because I know I can (or i did 3 years ago)...I lost 50 lbs...it's under that that I can not seem to get.

[mama angela 22]

so, I met with my doctor to start with and told her I wanted the lap band. She referred me to the"WLS diet program", where I met with the nurse, nutrionist and physcial therapist. The nurse kept my doc informed of my progress. The insurance is saying that I should have met with my doc each one of those months so they are not counting it as a "dr supervised" diet.

[Karen WS 78]

Mama Angela- I call my BCBS as soon as I made the decision to see what their requirement were. Every insurance is different and we can't expect the surgeons office to know the specific requirements for every insurance carrier. One thing I have definitely learned when it comes to elective surgery is to be pro active and take matters into my own hands. This is my journey and I wanted to be in control of it from the beginning. BCBS was great to work with, I especially like my nurse advocate. Call your insurance and ask the questions you need to know. I wish you all the best on you journey!

[Connie26 33]

This thread is making me so nervous! My surgeons office has me meet with a physicians assistant every month of my 6 month supervised through insurance - and I only met my surgeon in person 1 time. I hope this doesn't effect my approval as well :-( my last appt with the PA is this week... :-/

[Karen WS 78]

Connie don't be worried call your insurance carrier and verify what you have done and what still needs to be done. It will be fine. Best wishes