Medical Necessity

[carchaser 0]

Hi. I have a BMI of 40.7. If my doctor writes me a letter of medical necessity, I can avoid the six month diet that I think my insurance wants me to do? I have BCBS Wyoming.

[PSJ71 0]

Hi. I have a BMI of 40.7. If my doctor writes me a letter of medical necessity, I can avoid the six month diet that I think my insurance wants me to do? I have BCBS Wyoming.

Hi Car,

I have Aetna PPO, but usually when the insurance companies want you to follow a 6-month or 3-month doctor supervised diet, they most definitely want you to do these. Reason being, is they want to see how committed you are to being able to adhere to what is needed for success after banding, as well as (at least in my clause in my insurance) they feel if there is ANY weight loss during that timeframe, that helps the risks of the surgery go down. Look through your clause in your insurance and see if they won't accept a 3-month multidisciplinary diet. This is the one I opted for and did it with my bariatric surgeon. It's really not as bad as it seems.

I am actually thankful I went through that, because it helped me make a habit of logging things I eat and keeping accurate track of my exercise and eating habits.

Good luck to you!

[healthy-me-in-Az 0]

I have BCBS of Arizona. I did not have to do the 6 month dr supervised diet. They did require my BMI be over 40 for 5 years though.

Good luck to you!

[carchaser 0]

Thank you both for your replies. I can't find any supervised diet in my insurance clause, but they won't give me a straight answer. I've only been at a 40BMI for the past four years and only had one physcial during that time so I really don't know what they are going to say. I do have hypertenstion and a little pain in my knees when I squat. No one in the insurance seems to know what is going on and I'm frustrated.

[carchaser 0]

I found out I have to have 5 year medical history documentation. The problem is, I've been at a bmi 0f 40 during that time, and have only been to the doctor maybe twice. Any thoughts that will help me get approved?

[Headhunter 6]

PSJ71 is quite correct.

It's not that bad. And there are some very compelling reasons to do the pre-op diet, even though it seems like it "postpones" your surgery.

It doesn't, really, ...it PREPARES you for life with the Band. If you have 6 months of dieting in the way that will be prescribed, it will really help you when the Band is put in.

People very often complain about the pre-op diet requirement, but many will tell you that it really improved their transition into "band life".

It's a good thing! :thumbup:

HH

[RestlessMonkey 7]

Ask your insurance what they will accept as proof. It may be that you are out of luck, they may accept affidavits etc. Good luck.

[Ritalou 0]

I have BCBS Mich. I didn't need to be on supervised 6mo. diet, need to talk to...were you went to seminar, they can help you with your questions, they did me.

[paisleypea 1]

carchaser --- I didn't have 5 years documented from a dr. office history of BMI either. I also have BCBS (TX). That said, what I did was make up a chart with dates, weights, BMI, what diet I tried, what the result was. I had it going back to 1993 ----- way more than it needed to be, but I thought perhaps it would show a history of gradually increasing weights over time. Because I tended to lose 40 to 50 lbs per diet (and gaining it plus another 10 back.....) I was worried cuz my BMI wasn't high enough for the entire 5 year history.

I did "fudge" it just a bit too ----- but I felt it was worth it.

Then I gave that chart (I made it on my computer) to my dr. to add to my medical record. it then got sent on to the insurance company as part of my medical records. Your dr. might do the same for you.

Good luck!

[carchaser 0]

Thanks Paisleypea, I just got my criteria and in writing it says bmi 40 or over or 35 with a cormorbidity. So it looks good, but I'm leary they'll make me jump through some hoops.