Question:
Has anyone else been denied because no medically supervised diet in past 12 months?
I was denied by Highmark Blue Cross Blue Shield because I have not been on a medically supervised diet in the past 12 months. I have provided proof of medically supervised diets in the past -- Fen/Phen as well as a Very Low Calorie/Fasting-type diet -- put the last was in 1999-2000. I've since been on other diets. I live in Kentucky. My BMI is 41.2. I submitted letters of support from two doctors. I underwent and provided documentation on psychological examination and nutritional examination -- both supportive of the surgery. Yet still I was denied. It's so frustrating. Please share your experience, particularly whether you were ever able to get approval. — dotyel (posted on March 18, 2003)
March 18, 2003
Yes Elenor my sister has Etna and they made this rule up as they went
along. She's fighting it because she sent her info in before they made the
stipulation that you have to have 6 months with a doctor supervised
dietician. Think about it, are they so stupid to think that we haven't
dieted in our lives, or know nothing about nutrition? Most of us have done
anything and everything. I think each person should be evaluated by what
they've done in the past, i.e. your other doctor supervised diets. It's
ironic that they will pay for my sister to see this nutritionist and then
in 6 months pay for her surgery. But the way her BMI is over 50. And her
insurance company without compassion basically told her so what that they
saw people with that high of a BMI everyday. So I hear where you're coming
from and I can only suggest either you appeal or stay the course, follow
the diet the prescibe and you'll be lighter going into surgery. I'll pray
for you. Btw my BMI is 40 something and after supplying my insurance with
the MMPI and other information I was approved, but it took months. I guess
we should be thankful we at least have insurance that although have
stipulations, at least cover it. Just stay positive and don't let them get
you down. I hope and pray that you have a good support system. Good luck!
— cat F.
March 18, 2003
I am now in the process of beginning to seek approval from my insurance
company. I also have Highmark Blue Cross Blue Shield. Luckily, when I
called my surgeons office to schedule a consult I was informed about the
policies of BCBS and went immediately to my PCP to begin a medically
supervised diet. The only answer may just be to start the medically
supervised diet ASAP and while doing that make sure that all your other
"ducks are in a row." I have heard though, that at times
WeightWatchers or Jenny Craig or some other type of structured weightloss
program will satisfy an insurance company as far as "medically
supervised." Good luck and I will keep you in my prayers.
— Rhonda Y.
March 18, 2003
I was denied by BCBS of Florida on 01/29/03 b/c I did not have 12 mth of
supervised dieting by my pcp. I immediately had Walter Linstrom appeal it
for me and I got approved on 03/10/03. So yes it can be done. It was worth
every penny!!!!!!!!!!!
— lalulan
March 18, 2003
I too am having insurance problems. Our policy runs from July to end of
June. Last July 2 I called and got guidelines that had to be met before
having the surgery. They told me at this time I needed three documented
physician supervised diets of at least three months each, one being in the
last year. I Dec I went to PCP to start diet. Three months up March 3.
Now insurance is saying you need three diets of six months one in the last
year. I call today and told them policy could not change until July 1,
2003 and that I had spoke to Stacy on July 2, 2002 and she gave me the
guidelines for the year and that they could not change them now. She
agreed and told me to go ahead and have physician send paperwork to
insurance. I did just that but I am still preparing for a fight. We will
see. Just don't give up because that is what they want us to do. I know
it is hard but I just keep thinking it will all be worth it in the end.
Good Luck
— D. Bell
March 19, 2003
I was denied by my insurance (Anthem BC/BS)because I did not have 18
consecutive months documented weight loss efforts. They said the
documentation I had was not good enough because it did not chart my exact
weight. I was too large for the doctor's scale. I got fed up and decided to
fight it. I looked into hiring Walter, but I called my insurance first.
They told me there were other steps I had to go through before an attorney
could get involved. Anyway, I went through their appeals process with every
intent to hire a lawyer if I was denied again. My surgery was approved
through the appeals department. I went into greater detail in my profile
page. Don't quit fighting! Some insurance companies will do anything to
drag this out in hopes that you will give up. Don't let them win.
— Jenny S.
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