Question:
Has anyone been approved without a medically supervised diet history
I have checked the responses to this question, but haven't found any that answers exactly what I need to know. I have BCBS PPO and I just found out that they have sent a letter to my PCP requesting diet history. The problem is that although my doctor has given me diet sheets, he is not considering this medically supervised. According to his assistant who contacted me, medically supervised means that the doctor referred me to a licensed dietician and a history was kept of my weight loss attempt. Since this isn't the case, he will let the ins co know this. I also have documentation from another doctor I'd seen previously that did the same thing, told me I need to lose weight and gave me diet sheets, but never recorded my weight loss attempt. I have no medically supervised history to give to the ins co. I documented all the diets I've tried in the past, how much weight I lost and how long I kept the weight off and this was submitted by my surgeon's office along with everything else including a letter I wrote to the medical review board explaining what I've been through and am still. I'm terrified because the insurance co might deny me alltogether when they get this letter from my PCP. HAS ANYONE GOTTEN APPROVAL EVEN THOUGH THEY DIDN'T HAVE A MEDICALLY SUPERVISED DIET HISOTRY TO GIVE THE INS CO WHEN IT WAS REQUESTED. I am 150# overweight, diabetic, hypertensive, suffer sleep apnea, have severe back pain, shortness of breath and the list goes on. I thought this would be more than enough to get me approved. I have been overweight for 27 years (I'm now 34) and I need to regain as much of my health as I can. Please help, I'm going out of my mind trying to figure this one. — dandjon (posted on May 4, 2001)
May 4, 2001
Hi Donna. I was approved without any type of diet history request.I am a
military spouse and have Tricare as my insurer and they are pretty
strict,but I talked with my PCM and she took care of all that for me.I do
have co-morbities so I guess she played that up enough to convince the
insurance company to give me the green light. Good luck to you!
— Julie V.
May 4, 2001
Thanks for responding Julie, but what I really need to know is if the
insurance co requested a medically supervised diet history from anyone but
still approved the surgery although you did not have a diet history to
submit to them.
— dandjon
May 4, 2001
Donna, I have Blue Cross Blue Shield PPO, and I did not have any co-morbs
nor did I have a medically supervised diet list, because I always tried
diets on my own without the supervision of my PCP. I did not have any
problems getting approved. I just wrote down all of the diets that I tried,
and showed how much I lost and gained back. I was very detailed and I also
wrote a letter from the heart, telling them how much I needed this surgery.
Even if you cant think of all of the diets that you tried. Once you sit
down and write all of them down, you will see how long your list is, and
they will probably accept that from you.
I was approved by my insurance company in 2 days.
Hope all works out...Good Luck
— Ang B.
May 5, 2001
My insurance (Health Net) requested the information, I had never been on a
medically supervised diet. What I did provide them with were copies of the
actual physician's notes where (thankfully) she had noted "patient
advises losing weight with WW" and "patient losing weight with
low calorie plan." There was also a one month prescription for Redux.
Insurance considered that proof that I had worked with my doctor about my
weight. - Kate -
— kateseidel
May 5, 2001
DONNA, I HAVE BCBS PPO ALSO IN ILLINOIS. FOR YEARS MY DOCTOR ALWAYS
HANDED ME DIET SHEETS TO TRY TO FOLLOW. HE DIDN'T WRITE THIS DOWN. WHEN
INSURANCE REQUESTED MEDICALLY SUPERVISED HISTORY HE WROTE A TWO SENTENCE
LETTER STATEING I TRIED A LOT OF DIETS UNDER HIM AND THEY FAILED. BCBS
EXCEPTED THIS AND I HAD MY SURGERY 4-30-01. ASK HIM TO WRITE A LETTER HE
PROBABLY GIVES ALL HIS OVERWEIGHT PATIENTS DIET SHEETS EVERYTIME THEY COME
IN SO HE KNOWS HE GAVE IT TO YOU. AND HE CAN TELL BY HIS CHARTS WHEN YOUR
WEIGHT WAS RECORDED THAT THEY FAILED. GOOD LUCK.....JACKIE
— JACKIE S.
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