Question:
NEED 24 MONTHS SUPERVISED DR. DIETS.............!!!!!!!!
I have BCBS of NE. I have been denied despite all of the diet history and health problems I currently have. My physician says my health problems are weight related. I am 27 yrs old and have a BMI of 44.5. I have high BP, joint pain, asthma, shortness of breath, acid reflux, and trouble sleeping. Not to mention how uncomfortable I am every minute of everyday in my own skin. The ONLY reason they are giving me is that I have not had 24 months of Dr. supervised diets. I am furious!!!! I have seen this happen to people for a 12 month period but never 24. Does anyone have any suggestions on what I should include in my first appeal letter. My surgeons office is going to help me with it. I was thinking of sending them pics of me and my family. SUGGESTIONS ANYONE?????? — BUTTERFLYMACKEY (posted on June 3, 2005)
June 3, 2005
What kind of surgery are you seeking? RNY,DS,Band? You may want to post
this message to the MAIN MESSAGE BOARD, DS BOARD, or your STATE BOARD for a
better response depending on your surgery type.
— bubbles
June 3, 2005
Hi, I am in the process of getting it all started. My Insurance requires at
least 6 months supervised. When I saw my PCP the first time to get the
insurance criteria the insurance company told me ig I have NEVER had a Dr.
supervised diet that they might require a longer period of time. You might
want to make sure to inclued ALL the Dr supervised diets. If you have none
them you might want to start now befor the appeal letter. Who knows how
long the appeal could take so you might want to get a head start on the Dr
diet. I know that MOST insurances require at least 6 months to a year. Good
luck. I hope this helps you.
— Amanda A.
June 3, 2005
I can understand your feelings of frustrations. I know you probably won't
want to hear this but my insurance required me to have five years of
supervised diets. Thankfully I had that and then some. I'm sure your
doctor has documented every visit with your weight, and problems associated
with obesity. There could be a chance that you won't have to wait the 24
months. I really hope that everything goes well for you.
— Belle
June 4, 2005
Does it have to be a doctor's diet plan? I had many documented diet
attempts, (I'm a saver..had years of canceled checks), Nutri-System, Jenny
Craig, Richard Simmons, WW, etc. and my ins. accepted those. But I did have
my surgery 2 years ago, maybe the "rules" have changed since
then. Good Luck!
— j D.
June 5, 2005
I know this isn't a helpful reply but don't the idiot insurance companies
realize that most anybody can lose weight? We are going through this
because it is one of the few things that has a statistic of weight
MAINTENANCE associated with it.
— Jenny X.
June 5, 2005
Thanks for all of your help. I will repost this in the Main Forum. Good
luck to you all.
— BUTTERFLYMACKEY
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