Do most insurance companies require....

[Rivieramaya05 0]

you to be on a supervised diet for an extended period of time before they will approve the surgery?

[MrsFlipFlops 2]

Everyone is different. Mine require a supervised diet unless you have significant weight complications and a history of being overweight. Best thing to do is just call the insurance company and ask them.

I have UHC and all I did was have the doctor submit the request, it was approved within a few days!

[Jersey Boy 0]

Horizon BC/BS of NJ does require a six month supervised weightloss progahm before approval. Up untill Jan16th they did not require it but they changed (six days before my scheduled surgery). I never did weight watchers or any other plan like that. But I'm working on it now.

[shelly1066 0]

I am with BCBS of Mass and they didnt require really anything from me, thank god. I acutally was told my surgeons office that I needed 5 years worth of medical records along with "proof" that I was on a weight loss program and I needed none of the above! BUT I have heard from others in my support group that they have to fill all sorts of criteria before they will approve their surgeries. Mine approval was actually submitted last Friday and approved today (Tuesday) and surgery is scheduled for March 13th!! GOOD LUCK and DONT GIVE UP!!

[Cocoabean 430]

My denial for consult was due to the fact that I had not done a 6 month physician supervised diet. I appealed with weight watchers records, diary entries from other attempts I had done and also that the National Institutes of Health does not state that a 6 month plan is necessary for a good outcome from WLS.

I won the appeal and did not do a 6 month plan. Although it took nearly that long to get all the paperwork in order!

Denise

[vessa 1]

when i went in for consult, the physician I seen asked me what weight loss techniques I tried. I had a nice long list to tell him (but not a shred of paperwork) When the clinic filed my paperwork to the insurance company, I'm figuring this is "attempted weight loss programs before surgery" (as I said I had numerous doctors tell me to lose weight). Also, I had to have pyschiatric counseling at mayo (prerequisite to all bariatric surgery there) and regular checkups for about 5-6 months with mayo, as I "prepared" for surgery (longest 6 months of my life, not what I liked, but seems so short now...)I occasionally seen the nutritionist. This I'm guessing is more likely the "supervised diet", as they asked me to keep a diary of foods eaten, and then "looked them over"...so they could chew me out or call me a liar..haha, either way, some do some don't. I called insurance way before i even seen doctor, and since pipsqueak rushed me on the phone so quick, I just asked him to mail me all insurance info regaring bariatric surgery. He did, and I showe them at mayo, and made sure before they finished with me before sending paperwork, I had completed all their requirments. I was approved in 8 days, over the holiday.

[My Life Back 1]

My denial for consult was due to the fact that I had not done a 6 month physician supervised diet. I appealed with weight watchers records, diary entries from other attempts I had done and also that the National Institutes of Health does not state that a 6 month plan is necessary for a good outcome from WLS.

I won the appeal and did not do a 6 month plan. Although it took nearly that long to get all the paperwork in order!

Denise

Hi Denise -

I was wondering if it was possible that you could send me a copy of the information that you submitted regarding the National Institute of Health. I haven't been denied or accepted yet. I am still going back and forth with my PC to get the "proper" referral letter :confused2:. But I would like to be prepared in case they do hand down a denial.

I would greatly appreciate it.

Thanks so much in advance.

Becky

[Tracyde730 7]

All are different, but mine does. I need a 6 month doctor supervised diet...I'm on my way & my surgery is scheduled for August 1st...Good luck to you!

[ronwifey 0]

I have BCBS FEP and I didn't have to be on any kind of diet. Just have BMI of 40.

[Cocoabean 430]

Hi Denise -

I was wondering if it was possible that you could send me a copy of the information that you submitted regarding the National Institute of Health. I haven't been denied or accepted yet. I am still going back and forth with my PC to get the "proper" referral letter :confused2:. But I would like to be prepared in case they do hand down a denial.

I would greatly appreciate it.

Thanks so much in advance.

Becky

Hi Becky,

The lack of a 6 month program is the only reason my insurance company quoted for my denial.

Here is the link to the NIH Opinion:

The National Institutes of Health (NIH) Consensus Development Program: Gastrointestinal Surgery for Severe Obesity

If you can see a copy of Weight Loss Surgery for Dummies, it has several ideas for an appeals letter. This is what I used as the basis for my appeal. I used my own info of course, but it was effective. I pretty much plagerized the part about the NIH in their example letter.

I said something along the lines that the NIH 1991 consensus on obesity surgery does not mention a 6 months physician supervised diet program as a requirement for obesity surgery. I went on to cover my co-morbidities and made copies of diary entries from previous diet attempts and also previous Weight Watchers attendance information.

I stated that will all of my previous attempts, one more is unlikely to produce sustainable results.

Good luck! I hope you do not need to file an appeal, but it is good to be thinking about what you will write if needed.

I sent it to my insurance company and my primary care doctor.

Denise