Insurance criteria help needed.

[tryingforever 5]

Is there anyway to get around the insurance companies medically supervised diet for the last 3 yrs. I was on a medically supervised diet in 1998 but am told that's too old. For the last 5 yrs. (once a year) I've been on a medically supervised HCG injections diet but am told that won't work because it's pharmaceutical. In between then and now (like most of us) I've been on a million different diets (eg. WW, Jenny Craig, L.A. Weight Loss,etc, etc. ad nauseum) ahhhh- what can I do. So frustrated!

[DELETE THIS ACCOUNT! 12,703]

If that is your insurance company's requirement- then unfortunately no. There's no way around it.

[lisacaron 5,075]

Tryingforever....

Speak to your PCP. If you see them regularly and they know you are having weight issue...perhaps they can go back through you chart for 6 months.

My PCP had no problem signing the forms the insurance company required just by going back through my chart. I post dated the forms for the 6 months and sent them to the Surgeon and the insurance company and all was well.

My PCP knows me well, and knows that this was something I needed and that I would be healthier because of it, she had no issues helping me to facilitate that goal.

Talk to your docs the worst they can say is no. Best of luck to you!

[tryingforever 5]

Thanks! I have an appt. w/ my PCP who already knows this is what I want. I am hoping he will help me. Your post is a pick me up.

[tryingforever 5]

Thank you Lisacaron- talked to my PCP and he is willing to help me. More hurtles to jump but at least the PCP will be supportive.

[pokerkat 6]

Are you sure it's medical supervision required for 3 years? That's 3 continuous plan years. Your benefit is likely to change in that time. My requirement was just to write out a 3 yr history with results and then go through a 6 month supervised diet plan which I did with my surgeon's on site nutritionist. Look at your benefit again. It may just be asking if you were on anything supervised in the last 3 yrs. I work for a medical ins company and i don't think they can require you to complete anything that takes longer than the benefit plan year unless they are calling it pre-existing? Which is usually one plan yr. If 6 months is the correct time, then I also suggest waiting til you're made aware of your benefit for next year and that the band is still covered with the same requirement. This usually happens around November for employer group health plans. Some in my surgeons office started their 6 month requirement around August last year only to find the benefit was excluded this year and they couldn't have surgery. Alternatively, i made my Feb 2013 appt in Dec of 2012 and expected to be banded in Feb or March only to find that my ins company added the 6 month requirement as of Jan 2013. So my authorization did not come through til the end of Aug and I just had my procedure done on Sept 30. It's a long process but you can make it. Use your supervised time to try to learn new eating and fitness habits and drop some weight. It'll be less weight to worry about after surgery. Good luck. I hope all goes well.

[Bandista 7,466]

Thank you Lisacaron- talked to my PCP and he is willing to help me. More hurtles to jump but at least the PCP will be supportive.

Good news! One step at a time, one overly thoroughly excruciatingly documented step at a time......but it's working! Keep at it!

[Bandista 7,466]

Thank you Lisacaron- talked to my PCP and he is willing to help me. More hurtles to jump but at least the PCP will be supportive.

Good news! One step at a time, one overly thoroughly excruciatingly documented step at a time......but it's working! Keep at it!