Lisa S.
Heart Breaking News!!
Jan 24, 2012
I can't believe this. I called my doc's office today to ask about the nutrition class I needed. They informed me that the criteria for my surgery is 2-3 years medically supervised weight loss!!! When I started this process in September it was only 6 months. And here is why: I have Nevada Medicaid. When you first sign up and are approved, you have "straight medicaid HMO" until you are assigned a group. Straight Medicaid HMO requires 6 months medically supervised weight loss. So for 1 month, that was the coverage. Once you are assigned a group the criteria changes to: "Documentation supporting the reasonableness and necessity of the surgery must be in the medical record, and should include a 3 year documentation of medically supervised weight loss and weight loss therapy including recipient efforts at dietary therapy, physical activity, behavior therapy, pharmacotherapy, combined therapy, or any other medically supervised therapy."I am anal. (LOL). But they are using the word "should". I take that as meaning it is a good idea. But not a deal breaker. This is a contract. The word "must" is not open to interpretation. Why didn't the criteria say must??? I want to fight it. But my doc won't send for prior authorization based on the criteria.
I am thinking that maybe I should find another surgeon who will fight for me, or even a lawyer. I live in Las Vegas. My surgeon is Dr. Umbach. What do you all think????
4 Comments
About Me
NV
Location
30.5
BMI
Surgery
07/09/2012
Surgery Date
Nov 30, 2011
Member Since
