I have seen this ? asked so many ways but not close to mine

[doingit 0]

You guessed it, 6 month diet. I have done the following and do not know if I should push the submission to the insurance company after pysch eval. I have BCBS of Texas. They indicate that WW is acceptable. I have done the following this past year.

11/07 dr weigh in talked about surgery

12/07 wieght/BP check w/nurse and went to dietician

01/08 wieght/BP check w/nurse

03/08 joined WW and at same time had Dr complete medical necessity form for health care spending account reimbursement. On it he indicated obesity etc and need for lifetime ongoing commitment. Sill going to WW since then, so have a little over 10 months, but did not weigh in monthly with dr.

11/08,12/08 and 01/09 weigh in w/dr and he completed surgeons progress note form which proves we specifically discussed weightloss/modifications.

Now by the time I get my Psych consult I will have 4 consecutive weigh ins w/progress note form. Insurance clerk is hesitant to send before an offical 6 months of completed progress notes. My opinion is then why does the insurance co state WW is acceptable but at the same time they expected me to visit the dr each month as well? would you wait the 2 more months for a greater chance of approval or move forward and take a chance that since he signed the medical necessity form he was approving that method of dieting? meet BMI/co-morbidities and 5 years.

thanks sorry for so much detail but I hadn't came across any threads with this mixture.

[RestlessMonkey 7]

Why can't you do both? Submit the stuff, but keep at it and do your 2/09 appt with doc. If they deny you, then you'll just have 3/09 and can resubmit.

[HeatherO 7]

I agree with RestlessMonkey. If you can submit, go ahead and try but just know that you may very well end up with a denial. In the mean time, keep your appointments and get the progress notes.

That way you can keep pushing for success both ways at once . . . and if they do approve you on the first submission, then you will be that much closer to your surgery date. You never know, you might get lucky . . . but in the same token don't allow yourself to get too dissapointed if they deny you on first submission.

[doingit 0]

Thanks for replying HeatherO and restlessmonkey!!! Well I got a suprise today. Was talking to a co-worker and she told me she had to meet with a nurse 7 times for one hour. I thought that was odd since I didnt see anything in the med policy about it, nor did the customer service rep mentioned it when I called to make sure WLS was not excluded. And sure enough I seen a glimpse of it under the provider section that lifestyle coaching program was required on top of meeting medical necessity. Glad I happened upon that so I can get started on those sessions as well!! As long as they are willing to try to meet weekly with me I will be fine, if they throw in a monthly schedule I will be very disappointed. Wouldn't you have thought this information should be in the medical policy or in the section of my certificate that states wls is covered if medically necessary??? :biggrin:

[RestlessMonkey 7]

There are insurance companies who will pay for the coverage but they are REALLY reluctant and act like spoiled kids. They hide the info you need, etc. Hang in there! I'm glad that you caught it NOW! Good luck to you!