Just need a Suggestion

[RickinTN 0]

My insurance does cover the surgery. But, they require documentation that more conventional methods haven't worked. First, if more conventional methods did work, then I wouldn't be in this situation. Second, I haven't been on a doctor guided plan per say because all my doctor has said is that I need to lose the weight and has given me copies of diets. But, he hasn't followed me through them. They will also accept something structured like Weight Watchers or something. The only things I've been through is Men's Health Personal Trainer / Ab Diet and The Biggest Loser Club. And, I don't know if they would count them or if I can even get documentation from them stating I paid them for their services. Does anyone have any suggestions on how to get around this or do I need to tell the doctor he needs to monitor me closely for 6 months and then if it doesn't work, then try the surgery. I see him in the morning. Here is how it reads:

1. There must be documentation of medical evaluations with a history of medical / dietary therapy failures (e.g., low calorie diet, increased physical activity, and behavioral reinforcement). The provider must submit the following:

1. 
   

• Evidence that the attempt at conservative management was within two (2) years prior to the planned surgery. An attending physician, who is managing the care and weight loss of the individual, recommends the bariatric surgery and documents the failure of conservative management. This physician must be someone other than the operating surgeon and his / her associates.
  

[boredryu 0]

get all the documentation you can. Then if they still deny you appeal the decision and a committee will review your request. If it's obvious you tried they'll have to approve you.

[FinallyFree 1]

Rick, If you went to your dr. for wgt loss, there would be documetation from the dr. stating he told you to lose wgt and how much you weighed at the appt.

I had 5 years of my medical records from 5 drs. sent to the insurance company. It showed a steady wgt. gain, minimum loss. But every visit had a wgt. even if the visit was for a sinus infection, etc.

Good luck!

[Tomasa 0]

My daughter is going thru this process now. She went to a bariatric Dr. They sent her paperwork to insurance w/bmi weight etc. They told her the insurance would deny on the first try. The insurance wanted 6 months of supervised diet/nutrition plan. So my daughter goes in once a month to have her weight taken..she went to a nutrition class...that office documents everything...and will send in the paperwork after 6month. The bariatric center said that the insurance then approves 90 percent of the patients on the second time. Of course this process is not so easy if you have an HMO. Good Luck!

[RickinTN 0]

That's basically what the doctor suggested I do. He told me to go on a 1200 calorie diet and try to exercise and keep a log. Once a month, I will come into the office for a weigh-in. At the end of 6 months, if it isn't working, then we will submit it to the insurance for approval. He doesn't seem to think the dieting will work because of my genetic make-up. Everyone in my family is morbidly obese and has been all the way back to my great grandmother that I know of.