Amerihealth/Multiplan Criteria

[msjessy 0]

I am in the very beginning stages of this whole process, and want to make sure that I will qualify for the lapband thru my insurance, as with copays and time off this can become costly. I contacted my insurance Amerihealth/Multiplan and it appears that I have met all of the required criteria, but there's one I am still unsure of.

This is what is says in my policy:

Has documentation of a failed history of medical weight loss.

What exactly does this mean? Like some other posts I've seen, I rarely went to my doctor unless I was dog-sick, and any diet and/or excercise plan I have been on I did on my own.

Does Medical Weight Loss mean a supervised program? For the times I have gone to my PCP we have discussed weight, and ways to lose, but I"m not sure if these conversations are even documented in my file.

When I questioned the Insurance rep about this she stated that she wasn't sure what that meant, and when I asked to speak with someone else who might, she said that person was the Nurse who reviews the files for approval, and that I could not talk to her.

Any help from my fellow bandsters would be GREATLY appreciated. Especially those that have dealt with Amerihealth.

TIA!

~Jessenia

[BANDIT GIRL 1]

I am in the very beginning stages of this whole process, and want to make sure that I will qualify for the Lap Band thru my insurance, as with copays and time off this can become costly. I contacted my insurance Amerihealth/Multiplan and it appears that I have met all of the required criteria, but there's one I am still unsure of.

This is what is says in my policy:

Has documentation of a failed history of medical weight loss.

What exactly does this mean? Like some other posts I've seen, I rarely went to my doctor unless I was dog-sick, and any diet and/or excercise plan I have been on I did on my own.

Does Medical Weight Loss mean a supervised program? For the times I have gone to my PCP we have discussed weight, and ways to lose, but I"m not sure if these conversations are even documented in my file.

When I questioned the Insurance rep about this she stated that she wasn't sure what that meant, and when I asked to speak with someone else who might, she said that person was the Nurse who reviews the files for approval, and that I could not talk to her.

Any help from my fellow bandsters would be GREATLY appreciated. Especially those that have dealt with Amerihealth.

TIA!

~Jessenia

Hello Tia. I know how you feel. I called my insurance a few times on the very same subject and go a run around too. I was flabergasted(lol) that they couldn't answer my question. Afterall, aren't they the ones who are supposed to have the answers? Then when you submit the paper work they wanna reject you. I don't know what to tell you but keep trucking along and i wish you luck!