Insurance came back..

brneyezz · July 27, 2005

They need a years worth of documented medically supervised history of weightloss. Does anyone know how detailed it has to be? Thanks for your help, I feel so depressed now.

Heather Joy · July 28, 2005

i had soooo many documented weightloss --i went to weightwatchers,2 different gyms,2 nutritionists,LA Weightloss,Richard Simons,Xenical,etc... Stuff like that. If you know youve toldd your doctor youve tried losing weight through such programs and usually they are willing to send over a few pages to your surgeon. Good luck hopefully that will help. let me know if you need anything else:)

FRECKLES3 · July 28, 2005

I Work For An Insurance Company And When We Ask For That It Can Be Submitted 2 Ways...by The Physicians Medical Records Or By The Patients Own Records. I Sat Down And Wrote Out Every Diet And Exercise Plan I Tried And The Insurance Company Accepted It!!! Check And See Exactly What You Can Turn In For That!!! Good Luck

brneyezz · July 28, 2005

Thank you for all who responded. The criteria states as follows:

A documented failure of twelve (12) continuous months of compliance with medically supervised non-surgical methods of weigh reduction. Medical supervision must occur under a MD, DO, or nurse practioner wihtin the previous 24 month period prior to the request. A medically supervised weight management program is expected to consist of:

1. Nutrional therapy or medical nutrition therapy including a very low calorie diet (ie., Medifast or Optifast) unless contraindicated,

2. Behavior modiciation or behavioral health interventions

3. Supervised increased in activity

4. Pharmacologic therapy

5. Maintenance support to continue to encourage nutrition choices to reduce health risk factors and amaintain a healthy lifestyle.

Alexandra · July 28, 2005

Beth, it sounds as though your doctor is going to need to provide notes for you. Have you been seeing any doctor in the last couple of years in an attempt to control your weight? My carrier had a similar requirement (for six months, though) and it was satisfied by my doctor's notes that I had sought treatment for my weight issues over the last couple of years.

If you don't have such a record you may just have to pull up your bootstraps and get started now. A year isn't all that long, and will go by very quickly. Call your PCP and make an appointment right now to start that medically supervised weight loss program!

brneyezz · July 28, 2005

My doctor has March 2003 diet pills and January 2005 and June 2005 so worse comes to worse can starting going and then apply in January, my only fear is if they stop covering it by then.

Mystyblu · July 29, 2005

Beth –

I know the feeling. My ins. co wants 6 months of doctor supervised plan and I started it last month so I have 5 more months to go. Right now my ins. covers the surgery but who knows what will happen with open enrollment for next year. But all we can do for now, is to do what ever we need to now to get approval and worry about things that may change when they happen.

Heather Joy · July 29, 2005

i remember one of my ins requirements was that i had to have a medical condition DUE to my obesity.WHAT?!?!?!I dont have any medical problem like diabetes,high cholestoral and id prefer not to wait until i did to have this surgery!!i wrote them a letter pretty much stating that(along with all my other medical proof) and got approved

i think maybe they might have changed that part since thats not right at all,considering how young i am and are lots of people trying to get this surgery!!