Will I be denied again???
I was denied by my insurance co. (First Health/ Coventry) for not showing medical nec., which turned out to be the lack of documentation of a 6 month MD supervised diet. I went to a nutritionist for 2 months and then (after denial) went to my pcp and asked for 6 month diet . The problem is that the surgeon I'm required to see is in CT. I live near Albany NY. There is no communication between the PCP and surgeon. PCP is reluctant to do much because "it's not how it's done w/ our surgeons locally." I have not lost any weight...in fact I have gained. I even was given a script for Adipex that worked for like 2 days. Do I resubmit now ? My PCP says I should lose 10% because the insurance company wants to see I can change my eating..... I CAN'T LOSE WEIGHT ANYMORE!!!!!!!!
Will I be denied for not losing weight???? If I could lose weight I wouldn't need the surgery! I am so frustrated feel like I am turning in circles ! I am debt because of testing that I had to go though to get me this far and now it seems it won't be happening.
Any suggestions????
HI Heidi,
I know you're down right now, but pick yourself back up. Most of us are required to do some duration of medically supervised weight loss, so you're not alone. I could go on and on about why the insurance wants you to go through this diet, but Paul says it best. Please check out his profile. I agree wholeheartedly with every reason he gave for the medically supervised weight loss. Your doctor is correct, the insurance company wants to make sure you're ready for the change. Check out Paul's profile and do what you've gotta do. You deserve to have a better life.
Some insurances will allow you to combine different periods of time to make the 6 month requirement. For instance, you saw the nutritionist for two months and you saw another dr for a month. They may take those 3 months and only require you to complete 3 more months.
It's not the end for you. Keep trying and keep your head up.
Good Luck