Insurance Co. requires 6 months of documented medically supervised wght loss plan

circa · September 21, 2007

Apparently, even though I've had 6 months of diet/exercise/weight loss drugs from my PCP, my insurance company wants yet another 4! Uhm - that's not what their qualifications say! AND its going to put me into next year, which means I have to meet my deductable again. I am really so not happy about this. Especially since with all the pre requisite stuff that I already met, the surgery center and I were both looking at a mid-october date for surgery :waytogo:

faithmd · September 21, 2007

Apparently, even though I've had 6 months of diet/exercise/weight loss drugs from my PCP, my insurance company wants yet another 4! Uhm - that's not what their qualifications say! AND its going to put me into next year, which means I have to meet my deductable again. I am really so not happy about this. Especially since with all the pre requisite stuff that I already met, the surgery center and I were both looking at a mid-october date for surgery :eek:

If I were you, I'd appeal that in a heartbeat. As long as you can document that you have fulfilled their written policy, they should have to approve you. If you have trouble, it might be worth contacting Obesity Law and Advocacy Center For a few hundred dollars you may be able to save yourself fulfilling a big deductible.

Savedbygrace · September 22, 2007

<p>I agree with faithmd. If you did exactly what's written in their medical policy, there is no need for 4 more months. I would review the policy and appeal!</p>

circa · September 24, 2007

I'm waiting to hear - my patient advocate was going to recheck on the issue - hopefully it was just something overlooked. If not, I'll appeal.

Freebird · September 28, 2007

Donna, did you have to do the psych evaluation? I did mine two days ago. The psychologist could not stop saying the "f" word or talking about himself. I am anxiously waiting to see if I "qualify" for the surgery according to him. So, right now, my life and health lie in the hands of a man that can't stop saying the "f" word!!! Talk about depressing.

Donnajade · September 30, 2007

Freebird, yes, I had to do the psych eval and a nutrition eval. Hmmmm, my psychologist didn't use the F word once - wonder if I missed something??? *smile* Did you spend the whole hour talking about his problems? Don't worry - he probably can't remember if he thought he should approve you or not so he'll just approve you! Seriously, I was worried a bit about mine but I just answered her as best I could and at the end of my session she told me she was approving me. He has probably already sent his approval to your dr. You have a couple more months of the 6 month diet? Has your surgery dr. already given you a surgery date?

Donna

jennypoo1 · October 2, 2007

that is some garbage. I think that is a ploy so they can discourage up from going through with it. All the more reason to do it and tell them to kiss you a$$! My insurance company wont even pay for the surgery, so i'm struggling with that! Keep going I know it seems like a long time, but hey at least they will pay for it! Best wishes!

circa · October 2, 2007

that is some garbage. I think that is a ploy so they can discourage up from going through with it. All the more reason to do it and tell them to kiss you a$$! My insurance company wont even pay for the surgery, so i'm struggling with that! Keep going I know it seems like a long time, but hey at least they will pay for it! Best wishes!

I think its their way of ensuring that you're really determined to do it. If you'll sit there through all that, then you're ready for the next challenge that the surgery will bring you.

JulieC · October 3, 2007

I am so glad I found this thread! I am also waiting my six months, hoping to have surgery in Janurary or February. I am just trying to be as patient as possible. I have been heavy for so long I guess a few more months wont make that much difference. I am lightly dieting I guess you would say. Just biding my time and trying to not go below 40 bmi. Good luck to all of you too!

rtgirl77 · October 5, 2007

Just an FYI, I had BC of Cali and they required the 6 month thing also. My dr. said that she had documented at every visit that I was doing a weight watchers type program. The fact that she did that saved me from having to wait. We simply sent in the progress notes from my visits and that was sufficient. Basically, at every check-up, she would say that I was overweight and needed to lose weight and I'd say, "Uh yeah...I know...I'm doing weight watchers (or whatever the diet of the month was)" She just wrote down a few notes about that and it was sufficient for Blue Cross.

Just a thought.

jennypoo1 · October 5, 2007

I hope i can get a cool doctor like that. Right now i'm still trying to figure out if my insurance policy excludes bariatric surgery, I'm gotten 2 different answers.

brez1015 · October 5, 2007

hello all,

i am going to the doctors today this is the end of my 4th month. i have been losing weight each month but now i need to gain some back because i don't want to go below 40 on the bmi. i can't win....

circa · October 5, 2007

They're checkin into whether or not what my doctor has done with me is sufficient - my advocate (she finally got ahold of me) said it SHOULD be - I'm gathering all my medical records from the last 5 years. Its not easy being in a different state and timezone from most of your medical records. The doctors offices have been pretty cool about it though. The hospital back home said they'd have them to me in a week - they keep all the records for the doctors that no longer practice as well as the Urgent Care/Care Now walk in places - which will be my best bet for 2 of the years.