Insurance Changing Criteria

[sarcar 0]

I have a situation where three weeks ago, my doctor was sent a list of criteria that must be meet in order to have the lap band surgery performed. Now that I met all of that criteria and they have added more criteria. After meeting the first list which included showing failed attempts at weight loss for at least six months over the last two years, they have added/changed that you have to be on a doctor/nutritionist weight loss program for three months within the last six months. Can they change? How can I fight? I don't want to go on another diet for three months and find out that they then have a new criteria to meet? What are my options?

Also does anybody know what the goal of this additional weight loss program is? Am I suppose to succeed at losing weight for which we can all lose weight if you take away the food, but I just can't keep it off for extended periods of time. I want to make sure that I succeed at what they are looking for so I can get on with the surgery and my life changed.

Carolyn

[okiejudy 0]

Who is your insurance with. I too am waiting for insurance approval. I have been waiting since March 9. They keep saying they have not received the denial from my primary which we have faxed to them numerous times. I have United Healthcare EPO.

[Guest cammie]

Carolyn: I was denied two times before approved. You need to have your primary write your insurance company a letter stating that you HAVE tried to lose the weight, have lost, but are unable to maintain. If you have co-morbidies, this also needs to be included with a remark of how dangerous these are to your health and that this surgery is very indicated. If you have tried Weight Watchers or things like that, your primary doctor can also remind your insurance company that they (WW) do NOT maintain records, but that he/she is very aware and can assure the insurance company that you did indeed attend such diet groups. I tried Weight Watcher's and another program in my area, both of which did NOT maintain permanent records, however, my primary MD was aware and wrote a letter on my behalf that I did infact attend these groups, lost weight, but was not able to maintain. It worked, my insurance came back and approved me. I had my surgery on Monday May 2nd. I have lost around 15lbs. You do not need to give up. Let me know if I can help you further. Cammie

[sarcar 0]

The insurance verbally told me that the only thing lacking was the 3-month diet in the last 6-months. Today, I received a letter flat out denying because it is not medically necessary. I am over 100 pounds overweight with high blood pressure. Diabetes & Heart Trouble runs on both sides of my family. What do they really want? I don't know where to go. Carolyn