Question:
How can I fight my denial?
I have been denied, and I have a bmi of 48, IM 325 LBS, I have gallbladder disease, arthritis, acid reflux, urinary stress, irregular menstrual cycles,severe knee, and back pain. And I have been denied because I have only had my PCP for three months, and have not had a medically supervised diet for one year. But I do have a fourteen year diet history,but not under a doctors care. Please give me some advise and or help. Thank you, Melinda. — melindameyers (posted on March 27, 2002)
March 26, 2002
Melinda, I had my current pcp only a few months when I was trying to get
approved for this surgery and I didn't get denied. I just contacted my
previous pcp's and had them make copies of my previous records. Any
specialists or ob gyn's that you may have went to in the past, make sure
you get them too. The more records the better. Also is your current pcp
supportive of wls? If so have him write a letter of recommendation for you
listing your comorbidites. As for as the diet documentation, I created a
chart of all the diets I've tried in the past 10 yrs, medically supervised
or not and listed when I tried them and how much weight I had lost. I also
wrote a personal letter to the insurance company on how this surgery will
improve my health and my life. You have to be aggressive and fight for
what you want. I hope this helps and keep your chin up!!!--Jen
— Jennifer G.
March 26, 2002
I was denied for the same reason and I had attended Weight Watchers but
they no longer had my records so I had a friend who attended with me sign a
notarized statement about how well I did initially and how I then failed
and regained the weight. I also had gone to a diet doctor for a few months
and he had indicated in his records I was on weight watchers they accepted
this and I won the appeal.Good Luck if it's like my insurance company then
you have the right to appeal and the doctor had the right to appeal so you
have two chances if something like this doesn't work then you may want to
get an attorney.
— Candace F.
March 27, 2002
My surgeon asked me before I was approved for my surgery about all the
weight loss programs I'd been on. I think if I hadn't told him about all
those other programs, I probably wouldn't have been approved. Talk to your
PCP and let him know of all the diets you'd been on prior to seeing him.
Ask him to help you get it approved.
— dolphins94
March 27, 2002
Try to put together as much supporting information as you can for past diet
history anh weight related health problems. Does your policy cover WLS.
Also the one year medically supervised diet is not part of the NIH criteria
for WLS.
My BC/BS said same thing 1 year dr monitor weight loss.
If you have any further problems try hiring Walter Linstrom
(obesitylaw.com). He is a lawyer who had WLS and helps people get insurance
approvals. It cost me $350 and after 5 months of runaround & fighting
with insurance over denials, he got me approved within 3 days of submitting
my appeal.
— Dell H.
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