Question:
How would I appeal this reason?

I recieved a denial from my insurance stating that " patient has demonstrated an ability to lose weight but unwillingness to effect permanent healthy lifestyle changes." Any suggestions would be greatfully appreciated. I have several co-morbs and I really need this surgery. Thanks for all of your advice.    — Natalie J. (posted on September 30, 2003)

September 30, 2003
That is the most ridiculous reason I have ever heard. You would appeal it based upon the exact wording of your policy. I doubt it says that. They are using some guideline and hoping you will slink away. Any questions email me. G
   — gary viscio

September 30, 2003
We have all lost weight and have the ability to loose weight. The problem is keeping it off. With Co-morbs, GERD and a bmi of over 35 you shouldn't have a problem so, fight it and remember 70% of the people who get denied get approval when they fight and appeal. That goes to 0% if you don't. Good luck.
   — Dave H.

October 1, 2003
That is a ridiculous reason. I would fight it and arm myself with the NIH consensus development page on Gastric By Pass Surgery which clearly states that according to studies, only 2% of dieters can keep weight off up to 5 years and that WLS is the only proven way to keep the weight off. It also goes on to say that post-op patients can gain weight, but it is rarely more than 5% off their total loss.
   — M B.

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