Recent Posts
Topic: Supervised Diet - What is acceptable documentation?
I did two supervised diet programs but I'm concerned my documentation isn't good enough for insurance approval.
My first dr supervised diet was from a hospital that included calorie restriction (800 primarily shakes) and weekly meetings with weigh ins, and planned goals for exercise. I have three letters from this dr/hospital diet program which was sent to my primary care physician outlining my attendance, goals, start and progress, and the letters span over/past a 6 month period, but I do not have my weekly weigh in logs. Silly me I threw out my weekly weigh in logs and I did this purpously because I had lost weight and never wanted to see these weight numbers again. Obviously I was not thinking of bariatric surgery at this time. Unfortunaltey it took me all but two years to gain back all the weight I had lost.
My second supervised diet was from my primary care physician PCP, and I have copies of pharmacy records that indicate I was on Adipex (diet pill) for 10 months. I did see my PCP various times throughout this process but not monthly. I also did Weigh****chers during this time but I have looked everywhere and I cannot find my weekly logs from WW. I do have documentation regarding my registration into two - 12 week WW programs but not my weekly logs.
What do you think? Will this suffice? What have others used for approval and or appeals?
My first dr supervised diet was from a hospital that included calorie restriction (800 primarily shakes) and weekly meetings with weigh ins, and planned goals for exercise. I have three letters from this dr/hospital diet program which was sent to my primary care physician outlining my attendance, goals, start and progress, and the letters span over/past a 6 month period, but I do not have my weekly weigh in logs. Silly me I threw out my weekly weigh in logs and I did this purpously because I had lost weight and never wanted to see these weight numbers again. Obviously I was not thinking of bariatric surgery at this time. Unfortunaltey it took me all but two years to gain back all the weight I had lost.
My second supervised diet was from my primary care physician PCP, and I have copies of pharmacy records that indicate I was on Adipex (diet pill) for 10 months. I did see my PCP various times throughout this process but not monthly. I also did Weigh****chers during this time but I have looked everywhere and I cannot find my weekly logs from WW. I do have documentation regarding my registration into two - 12 week WW programs but not my weekly logs.
What do you think? Will this suffice? What have others used for approval and or appeals?
Topic: BCBS HMOBlue of MA
Hi, I posted this on the main forum earlier today but then discovered this forum and thought I'd post here. I have BCBS HMOBlue of MA and was told they don't cover the Sleeve as a stand alone procedure as they deem it experimental. I have already been approved for RNY which they do cover (they cover DS too but my surgeon doesn't do it). Anyone know how to appeal to them to have it covered? My surgery date was supposed to be 8/23 but has been pushed out to 9/13 which just gives me more time to get nervous and double, triple and quadruple question myself. Any info would be appreciated.
Thanks.
Meg
Thanks.
Meg
Topic: BCBS of IL PPO
Has anyone ever had BCBS of IL PPO that has had DS surgery? Did BCBS pay or deny? Any info would be greatly appreciated.
Thanks
Mary
Thanks
Mary
Topic: not the primary
I am not the policy holder on my insurance, that woule be my mom. I called and asked about gastric surgery and was told no.... I know many people are denied this off hand at first.... how do I get the insurance company to pay for this? I am bound and determined to do this.... I don't expect them to pay for it all... just the majority... my parents said they would help me with copay as long as it's not above a couple thousand. I just need to do this surgery and with my family history of heart disease, type II diabetes, and other obesity related diseases I want to avoid them (if I don't already have them!) What do I need to do?
THANKS!!!!
THANKS!!!!
Topic: RE: Letter of Medical Necessity - samples needed!
Hello... My name is Rachel, I am 5 feet tall.... sign in BMI 40.4... pleased to meet you!!!
Starting BMI between 35 and 40ish?
Join us on the Lightweights Board!
I was just denied for LAP-BAND through CIGNA HEATHCARE, Monday August 16, 2010... I plan to use NAN's sample appeal letter too!! My denial letter states the denial is from 09/01/2010 to 12/01/2010. Does that mean they wont even consider an approval until AFTER the denial period is over?
Hello... My name is Rachel, I am 5 feet tall.... sign in BMI 40.4... pleased to meet you!!!
Starting BMI between 35 and 40ish?
Join us on the Lightweights Board!
Topic: RE: priority partners ??
hi can you tell me how eveything works i live in gaithersburg md and have priority partners
Topic: RE: My ins co won't disclose pre-reqs to me
If you find out let us know, I am also in the same boat. I have contacted my insurance company and recieved the same answer. I had to put it back in the doctor's hands and see what happens. It is hard to deal with this part of it. Hope it works out well for you.
Topic: Is it even possible?
Is it even possible to get WLS with terrible credit (bankruptcy) and no insurance (self employed) ? I just wonder if it is even worth my time to try.
http://www.moretolifethanchocolate.com
My Blog. My Life.
My Blog. My Life.
Topic: RE: BMI Calculators

So - with a body fat of 43.5% and 90# of fat - does anyone know if the insurance company considers body fat in addition to BMI???
Sheri
Sheri

I've been fat, and I've been thin - and thin is better.
There is a better way. --Alaine of Lyndar
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HW: 234. SW: 228 (18 June 2015). GW: 137. Specs: 50ish, 5'4"

