Question:
2nd appeal denied, do not have 18 month weight loss records. Anyone else?
Insurance(bcbs) has denied surgery because I do not have 18 months Physician documented weight loss attempts. Am preparing new appeal. Any suggestions? I was not planning this surgery 18 months ago, did not have bcbs at that time, and had no reason to document weight loss attemps with my Physician. I meet all other criteria. Any suggestions? Thanks-- — Angela T. (posted on December 13, 2001)
December 13, 2001
Contact your doctor, even if you didn't keep records, he/she did. Ask the
doctor for a copy and send it to your insurance company. Good luck.
— Lynne R.
December 13, 2001
I have BC/BS also-and they want 12 months..I've never really tried any
diets w/her-although she knows I've been trying for alot more than 12
months, so she said as long as I go to a program (w/a dr. or dietician) for
a few months-she'd write a letter saying that she's been supervising my
diet attempts for a year or more...what did your PCP say? They're the one
that can make or brake this whole appeal!
— [Anonymous]
December 15, 2001
I had a friend sign a notarized affadative about being in Weight Watchers
since WW don't keep records past 6 weeks of non-attendance. My Doctor had
made a note in my chart about me being in WW whiched helped support it. I
was approved then. Good Luck.
— Candace F.
December 17, 2001
My insurance PHP, required the same thing but my weight was so severe and I
didn't feel like I had that much time to waste trying to document until
they felt like I had enough proof. I really believe these insurance
companies do these things to get you to give up, so they don't have to pay
for it. Be forceful, talk to the medical director if you have enough
evidence with your health problems that the surgery is medically necessary
then the history is just a technicality and a way for them to get out of
it. Try talking to Walter Lindstom's, he had the surgery years ago and is
an attorney now who helps others to get the surgery, he may be able to help
with your appeal. The rates are affordable and they gave me some
suggestions over the phone that helped me without having to hire them. I
finally told my insurance after the 2nd denial that I was going to fight it
because I had all the medical necessity they needed and they approved the
surgery the next day when I told them I was getting an attorney. Good luck.
— Monica F.
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