Denied-don't understand why? Help

katia1973
on 5/22/07 12:23 am
Lap Band on 01/25/08 with
Wondering if anyone has any information on what exactly Optimium Choice is looking for when they mean "Physican supervised weight loss program?" I've been on Adipex since 7/06 to help with weight loss and had documented weigh ins every month since December to May and they denied me because my documentation did not meet the criterea?  I was being seen for other things as well as the weight loss but does anyone know what exactly they are looking for?  Member services were not very helpful and only repeated documented "supervised w/l program"?  Has anyone had any experience with not meeting these requirements and then going forward for monthly visites to their doctor and resubmitting for approval? Thanks!
(deactivated member)
on 5/22/07 12:43 am - Virginia Beach, VA
I think they want the drs notes to read that you were being seen for your weight only. Call the ins company and ask them to tell you exactly what you need. If you don'y understand, keep asking them to explaine it. I had to do that a couple of times. Good luck. Corinn
SWEET Tink
on 5/22/07 9:35 am
They want you to be seen directly for weight loss . Each time documenting your begining weight and your ending weight . You will actually be seen 7 times . The first time is the consult with your PCP the next 6 times are the 6 weigh ins you will need to provide . Along with this , most provide a history of your eating habits with in the month , along with exercise .  IMHOP..... This is merely a tactic by the insurance comany to get you to quit .. and I am one that will tell you that if you want this bad enough .. you will do what they ask . Show them you can and will keep to their wishes .. and get the surgery you so deserve and need .  Call your insurance company in the morning . If you cannot get the answer that you want .. ask for supervisor .. if then you cannot get any answers .. go to your plans cooridinator .  Best wishes to you , I hope this helps .  Natalie
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