Question:
Will anything else be required by the insurance company if they didn't mention it?
My insurance company (Great West) denied me. They said they need a 6 month Dr. supervised diet. I am doing that now. What are the chances that when the diet is complete and I re-apply that they come up with some other "requirements?" I am trying to not get my hopes up......just in case, but it is hard not to. — lasias (posted on January 18, 2006)
January 18, 2006
The best thing to do is to contact the Medical Management (aka Medical
Review or Quality Management department) at the insurance company and ask
them to email or mail their criteria for bariatric surgery to you. That
way you have it in writing and have a basis for a future appeal if needed
if you have met all of their criteria. Good Luck - Cheryl
— classite
January 18, 2006
Addendum to above - I have Great West insurance in Washington State and
have already had them email me their requirements. If you would like them,
email me @ [email protected] and I will email them back to you!
— classite
January 18, 2006
Hi I don't have your insurance but mine did the same thing (BCBS-TRS).
After my six month I re-submitted my request along with a letter of appeal
naming all my medical history, cost of my meds. and how my weight affected
my life and my work. They ok'ed my request in two weeks. This is the best
thing that I have ever done for myself. Don't give up.
Laural
HW- 313
SW-292
PW-211
GW-135
— Laural D.
January 19, 2006
I also have Great West and was also denied after first submitting my
paperwork. I received my denial letter which included the reasons why they
denied me and what i still needed to submit. I also called my case
manager, who was assigned to me, and I asked her for the complete gastric
bypass surgery requirements; it was 10 pages. So be sure to call your case
manager, their name and number will be on the denial letter, and
specifically ask for the complete requirements. I also had to take six
months and complete a lot of things insurance wanted. Even though i've
joined weight watchers at least 15 times, i never kept my paperwork/weighin
book. So i did weight watchers again for 6 months; i also went to my pcp
once a month for six months straight for checkups to follow my weightloss.
I had my pcp document in my chart that i am attending weight watchers, and
she would take all my vitals, and weight. It is expensive to see the
doctor that frequently, and do weight watchers, but it's worth it to get
approved. There are a lot of other requirements and i can't type them all.
Anyway, after six months i submitted a bunch of more documentation for my
appeal, and i got APPROVED! It's really hard to wait six months to do all
of these things for insurance. The last 2 months i felt like quiting
everything and forget about appealing, but i had spent too much of my time,
my money, and i really wanted the surgery. So try and be patient with the
process and i'm sure you will get approved when you appeal. Good luck and
let us know how things go. Take care
— 757728
January 20, 2006
I was going to suggest you either find your insurance company's clinical
rules on line at their website, or ask them by phone to mail you a copy.
that way you will know exactly what to do and they can't change it on you.
— Novashannon
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