Question:
Am I going to have a big problem?

Hello all you wonderful people! I was trying to get some feedback from you guys... I just found out from the orthopedic surgeon that i have Patellofemoral syndrome which is a form of arthritis. He said that my cartilage is wearing down unevenly because my knee cap is not aligned properly so when i put pressure on it it grins and causes pain. What caused this with me? OBESITY!!! Bottom line he said was I am a nightmare waiting to happen and that by looking at my x-rays and only being 28 it is crucial for me to lose weight now. Being that i don't have any dr. supervised diets , does any one think this will push approval along in my favor? I mean I also have high cholesterol, high tryglicerides, and acid reflux also. I am going to the Neurologist on monday for leg pain that i have...oh and also i have fatty liver. Will all this out weigh the fact that i don't have supervised diets by a Dr.? I have Anthem bc/bs of Connecticut and what they require is Dr. supervised diets for 12 mo. and it must be medically necessary. I am also going to get a letter of recomendation from my PCP, and hopefully The Neurologist, and I spoke to the Orthopedic's assistent and she said that my records will indicate all the important information i will need. So, What do you think?????? Yes? sorry so long but this have been on my mind constantly~    — REBECCA L. (posted on July 3, 2001)

July 3, 2001
Hi Rebecca! Wow, sounds like you have enough health problems to qualify for the surgery, but it just depends on your insurance and what they require to cover the cost. I would send in any and all letters from your different doctors stating your health problems and what they feel the cause of the problem is. This can only help! One of my insurances is Aetna and it required a diet history, but my surgeon put sort of a summary into his request letter and then gave them my medical history and family history and they approved. I did not have to list out every diet for the insurance, but listed on a form for my surgeon to use in his letter. Every situation is different, but you need to be prepared for each of those situations. Just to be safe, I would get ALL of your info together before the first request is submitted to help your chances of approval. Good Luck!
   — gina P.

July 3, 2001
You may not have to produce evidence of doctor supervised diets. I had to document (from my own memory) supervised diets - like weight watchers, Jenny Craig, NutriSystem. If you participated in any of these you may be OK on that end. Your comorbids along with your BMI qualify you for the surgery definitely.
   — Lisa B.