Urgh...Are you on an insurance required diet?

A few weeks ago I received my initial denial letter from my insurance administrators (we belong to a self insured plan) stating that I was denied because I did not have 'Life-Threatening" co-morbidities and I lacked a three month physician supervised diet.  I immediately started the diet, but also sent a letter of appeal detailing my high blood pressure and GERD.  I asked that my surgeryu not be delayed because of the missing diet proof-as I have been dieting my whole life. Well, yesterday I received the reply-I am still denied because the surgery is not considereed "medically necessary".   BUT...the letter went on to say  "Once the patient completes a three months physician-supervised program, bariatric surgery will be medically appropriate." So, I still have two more months to go-and then the surgery will be approved.  I finally see some light at the end of the tunnel and it is NOT an oncoming train. The wait has not been easy for me-and I could use your support. Thanks!!! Lisa R

Hi Lisa, I know it is no fun jumping through all of the hoops but like you said, it is only a couple more months and that is pretty much an approval so you won't have to worry about that once this is done. My info was submitted to insurance on Friday so I am playing the waiting game now. Some companies require 6 months, 12 months and some even longer so consider it a blessing. Good luck girl. If you aren't already journaling start, maybe start to plan a scrapbook to keep up with your success... look for and start to gather the things you will need for your surgery (gown, slippers, robe, etc...) Just stay busy with other things and the time will fly by. Jenifer

Jenifer,

Best of luck to you also!  At least you are not waiting in  -3 degree weather.  It is so cold here that the schools are closed for the day.  On the bright side, my husband and I will be in Key West for Valentine's Day.

While the wait is hard, it is bearable-and I have been learining a lot and I know it will help me be more emotionally prepared.

Best of luck,

Lisa

Hi Lisa- BEEN THERE!!  I have a required 6-month dr-supervised diet and i am almost done!!! 3 more weeks to go... it has been SUCH a long time, and i've been on these boards the whole time. i can tell you that you need to have great documentation from your PCP,... ie. each months visit with the PCP Dr has to have your vitals, and what you talked about... and in my case, i had to consider 'pharmological alternatives" ie. prescription diet aids (like fastin ) and i've done that and actually lost 22-24 lbs! so thats good. i've read of denials where people who havent lost anything were denied for 'failure to comply' with their diet plan, so i i were you i would plan to lose SOMETHING to show you can comply with dr's orders.  but then again ive also read of people who havent lost a thing and were still approved. but for me i didnt want to chance it. good luck! stefanie

I just started a 6-month diet on Thursday.  Wish I just had to do 3 months!  I'm hoping to have surgery in August.  Hang in there Lisa!  I've been on lots of diets, but none were "physician supervised."  I hope I can lose 30 lbs. but it's going to be a struggle. 

Good luck Lisa!

Pam