Question:
DOES ANYONE KNOW WHAT THIS MEANS
INS.CO CAME BACK WITH THE FOLLOWING; THERE IS NO MEDICAL RECORD DOCUMENTATION OF MEDICALLY SUPERVISED WEIGHT MANAGEMENT INCLUDING NUTRITION THERAPY, BEHAVIORAL INTERVENTIONS, SUPERVISED INCREASE IN ACTIVITY, FOOD DIARY ANALYSIS AND MAINTENANCE SUPPORT. I DON'T KNOW WHAT MOST OF THIS EVEN MEANS, I HAVE TO DO AN APPEAL, AND FAST, BUT I DON'T KNOW HOW TO ADDRESS THESE THINGS IN THE LETTER WITHOUT FIRST BEING ABLE TO UNDERSTAND THEM ALL. ANY HELP WOULD BE GREATLY APPRECIATED. THANKS AND GOD BLESS, KIM — Kim R. (posted on October 21, 2003)
October 21, 2003
This is very simple. According to their records, you have not been to a
doctor to try to lose weight, you have not been to a dietician to try to
modify your diet, you have not joined an an exercise program, etc. They
need proof that you have tried everything under the sun to lose weight.
Until you do exactly what they ask of you, your appeal won't be worth much.
They told you in the denial letter what you need to complete before you can
be approved.. now you just have to do it, I'm afraid. Good luck.
— SarahC
October 21, 2003
It sounds like your insurance company wants documentation of ALL attempts
at weight loss. It sounds like your doctor did not include this or you
have not had any medically supervised weight loss attempts. Does it
actually say "We are sorry but at this time we cannot approve
you..." Or does it just say this? If its just this, its not a denial,
but a request for more information.
— Renee B.
October 21, 2003
I am having the same problem I'm afraid.....I have BCBS of Illinois - Blue
Choice PPO. We sent them all the stuff they required for me to meet the
criteria for surgery, which I did to a tee. Then they asked for the same
stuff that you are being denied for. My PCP sent them another letter that
was 11 pages long with chart notes, weights, blood pressures, and
co-morbidities that I was being treated for. In some of these chart notes
were places that discuss weight loss management, exercise and nutrition. I
have not heard back from Insurance since this was submitted but am afraid
that I will be denied for the same reason. If so I am going to try to get
the lawyer that everyone talks about to deal with the appeal (Lindstrom is
his name). It costs, but I feel it will be worth it if it comes to that.
The lawyer has a 90% approval rating after denial. Just a thought. Will
be praying for you.
— QUEENS B.
October 21, 2003
I'd check out walter lindstrom or another online obesity/bariatric lawyer
— Sandy A.
October 21, 2003
Aloha! Many insurance companies are now requiring documentation of
physician supervised diets. This means that Jenny Craig, Weight Watchers,
Adkins Diet, etc. are NOT allowed unless you were followed by your
physician during the diet phase. Most insurance companies want to see that
you have been to dietary counseling where they put you on a diet and
monitor your progress, and/or your physician has prescribed diet drugs.
Some companies require six months of a diet history. Some require up to 18
months. The best thing to do is to contact someone at your insurance
company to see what their minimum requirement is. Unfortunately, if they
have it written in their policy that you must have a documented diet
history, appeals may not work. I have known several folks that received the
same type of denial and have to start the process over again once they have
fulfilled their diet history requirements. Good luck!!!! Kathie in Hawaii
(Open RNY 08/07/02...down 167 pounds!)
— KathieInHawaii
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