Question:
I NEED TO APPEAL AETNA BECAUSE THEY ARE SAYING I DO NOT HAVE THE REQUIRED 6 MONTH
OF NUTRITION SUPERVISED DIET — joe G. (posted on April 20, 2005)
April 20, 2005
Contact Gary Viscio at http://obesitylawyers.com/ He is appealing my 12
month diet history denial with BCBS. He felt confident enough to take my
case so I'd give him a call or email him.
— maxsmom77
April 20, 2005
I hadve Aetna and they said the same thing to me. I did my 6 months and it
went by so fast. I went to my PCP once a month and he wrote down that I was
on a 1200 calorie diet and that I walked for 30 min every day (wich I did).
He updated it every month when I went in. I only lost about 10 lbs but that
is what they wanted to see. When they first denied me I thought that it was
the end of the world but after I did what they wanted it only took them
about 3 days to get me approved. I do know that here in Texas that it is
one of the majior req. I had diet history but it was not 6 cons. months. I
hope this helps you out.
Jaime
Dr. Naaman TX
12-27-04
278-210
— jaime
April 20, 2005
Joe... My insurance company is Aetna, also. They denied me for the same
reason but I appealed it and eleven days later the director of the medical
review board overturned the decision and I had my Lap RNY surgery March 18,
2005. Just 4 weeks ago. Don't give up. Fight them. It will work for you.
Good Luck in your future WLS.
— LindaKM
April 20, 2005
yes, you can appeal, you can hire an attorney, but it might be cheaper and
faster to just do the 6 month diet,If you get started now you could be a
loser before halloween!
— **willow**
April 21, 2005
I dont think hiring an attorney is necessary/What my pcp did was write an
appeal letter saying that I had modified my diet to 3meals a day. and I had
been walking at home or atthe gym 30-45 min a day and if you have attended
any group sessions or wls support meetings you need to list that and that
you are still attending . and she also listed my existing health conditions
such as hypertension, back pain etc.along with your current bmi and any
conditions that you may be at risk in having as a result of the weight.
thats all we did and they approved within 15 days of my appeal
— Bobbie R.
April 21, 2005
you need to quoat them thier new cbt 0157 which states in part,4. Member
must meet either criterion a (physician-supervised
nutrition and exercise program)" OR " criterion
b
(multidisciplinary surgical preparatory regimen):
THE KEY WORD IS OR/EITHER, NOT BOTH, THIS UPDATE WAS ISSUE 4/19/05
THE DIET HISTORY IS OUT, ITS THIER RULES,MAKE PLAY BY EM.
— walter A.
Click Here to Return