Question:
Did anyone have to do a 6 month diet for them first???

Hi-I was wondering if anyone who recently (past year) has gone for approval for surgery and they told them they had to do a 6 month diet first?? I have read e-mails in the past and it seems some do and some don't for Highmark.    — SharonBrown (posted on May 27, 2005)

May 27, 2005
They were going to make me do that through the nutritionists office in order for it to be counted as ONE attempt at weight loss. Unfortunatley it's the Insurance Co's. controlling our lives again! But I did go and see my PCP after I was told that I needed atleast 2 more nutrition appts, next thing I know he made a phone call and I was scheduling surgery the next week at my one on one with the doctor. Talk to your Primary Docotor...see if there is anything he can do to assists you. Goodluck...Hope all goes well.
   — trigem333

May 30, 2005
Sharon: We have Highmark PPO through my husband's employer, Rite Aid and I was required to complete a 6 month physician supervised diet and exercise regimen. Once that was completed and everything was submitted to them, my surgery was approved in less than 24 hrs. It was all worth it believe me! Surgery was 3/14/05 and I'm down over 60 pounds since then. Good Luck to you!!! Pam
   — pprater

May 31, 2005
Hello from Jeff Visit your primary care physician and request that he or she help you with documentation of your weight loss attempts. My Insurance company wanted 1 year of supervised weight loss before they would agree to pay for the surgery. I asked my primary care physican to send a letter documenting my failed attempts at substantial weight loss and my need for the surgery. As it turned out, over my entire adult life I had several years of supervise weight loss from different physicans and so I documented these attempts on my own in a letter that I submitted to my insurance company along with the letter from my primary care physicain. It would be a good idea for you to write a very extended letter to your insurance company also documenting your weight loss attempts during your entire adult life as this will give additional documentation of your situation, and focus on problems you are having with co-morbidities. That is basically what they are looking for, documetation of weight loss attempts to to prove medical necessity based on medical conditions related to co-mobidites developed from being morbidly obese. Most insurance companies are not going to pay for this surgery for cosmetic reasons. I was initally declined by my insurance company because I my surgeon did not submit enough documentation about my situation. I appealed the decision and had my primary care physican write a detailed explanation of my health situation and need for the surgery and sent my personal history document along with my physican's statment. The denial was over turned within 3 weeks. Best wishes and I am certain everyting is going to work out for you!
   — Jeffrey T.

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