Guest guest Posted August 29, 2003 Report Share Posted August 29, 2003 Sorry Liz, what about contacting the insurance commissioner in your state. File a complaint and fight them and let the ins. commission decide A. B. LAP RNY 3/22/03 BMI 65/54 386/312 - 74 LBS. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 29, 2003 Report Share Posted August 29, 2003 That is the pits!!! Don’t they know that the reason we are looking at this surgery is because “diets” don’t work for us. We might lose weight for a while, but it creeps back on, usually bringing more little “pound buddies” with it. Don’t get discouraged. Hang in there. Charlotte Pre-op (tomistic) So Sad I found out today that I have to go through 2 years of doctor managed weight loss (diets) before I can be approved. I am so sad. I've been working on thsi is Jan 15, and now I find out all the rules have just changed. I told my boss today that it would be at least two years before I can have the surgery. His reply " Praise the Lord " . I can't stop crying. Sorry, I just had to tell someone. Lizanne Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 29, 2003 Report Share Posted August 29, 2003 I have calmed down a little bit, but I'm lost. I have an appointment with my PCP on Wed. I want to discuss this with him. In two years I probably won't be able to walk. I have arthritis in my knees, hips and back. If I wait two years plus another 8 months waiting for approval and a surgery date, I'll be in much worse shape that I am now. I have been on doctor-monitored diets before, the one I stayed with the longest was with a doctor that retired, probably 8 years ago. I don't even know how to find the paperwork associated with that. That was during the phen-fen age, then phen-prozac. I have had doctor monitored diets since I was 13 when I was given actual amphetamines and they were legal. I have kept a food diary for years, that doesn't do anything to insure my weightloss, it just makes for boring reading. I live a sedentary life because I can't get around very well now, what's going to happen now. It seems as though I'm going to have to get un-healthier (????) before I can have the surgery, and then the risk of other failures will be greater. The arthritis isn't my only heath problem. I have hypertension, high cholesterol, and a fatty liver. How can they change the rules in the middle of the approval process. I even thought about contacting Dick Gelfman, the TV guy who solves all the problems, but living in the DC-Baltimore area, this is no attention-getter. I guess I just deteriorate for 2+ years until I get approval, by then what's the use???? I know I'm depressing you all, and I have been reading some great things that have been accomplished in the past few weeks. thanks for letting me cry on your shoulders Lizanne > That is the pits!!! Don't they know that the reason we are looking at this > surgery is because " diets " don't work for us. We might lose weight for a > while, but it creeps back on, usually bringing more little " pound buddies " > with it. Don't get discouraged. Hang in there. > > Charlotte > > Pre-op (tomistic) > > > > So Sad > > > > I found out today that I have to go through 2 years of doctor managed > weight loss (diets) before I can be approved. I am so sad. I've > been working on thsi is Jan 15, and now I find out all the rules have > just changed. > > I told my boss today that it would be at least two years before I can > have the surgery. His reply " Praise the Lord " . > > I can't stop crying. Sorry, I just had to tell someone. > > Lizanne > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 29, 2003 Report Share Posted August 29, 2003 In a message dated 8/29/03 8:29:39 PM Eastern Daylight Time, Gastric_Bypass_Family writes: > I found out today that I have to go through 2 years of doctor managed > weight loss (diets) before I can be approved. I am so sad. I've > been working on thsi is Jan 15, and now I find out all the rules have > just changed. > > I told my boss today that it would be at least two years before I can > have the surgery. His reply " Praise the Lord " . > > I can't stop crying. Sorry, I just had to tell someone. > > Lizanne Dear Lizanne, ::hugs:: I am so very sorry for you. That is not fair, at all, one bit. And I am sorry, and yes I am angry, that your boss had no right to say that comment. What did he mean " Praise his lord " ? That he didn't have to deal with extra work for a while, or it could be that he really cared, but still - to me it was absolutely inappropriate. ::hugs:: again. It will happen. Your day will come, Lizanne. I have hope. Fight it, Curse it, Do what you can to get the surgery. Don't loose hope! ~ /Seta Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 29, 2003 Report Share Posted August 29, 2003 (((Lizanne))) I hope you can find a way through this snafoo. I hate to see you have to wait so long, but feel that if this 2 year supervised diet can help you lose and maintain your loss, its a better option than surgery. I know its easier said than accepted, hon. Wish I could think of a way around all this. Toi Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 29, 2003 Report Share Posted August 29, 2003 Thanks for the reminder about how we can do anything we put our minds to, it's just that I'm worried that after I wait 2 years for the doctor monitored diet (which I've done 4 times before) then I wait for the consult again, then I wait 6 months in line for the surgery, my health will have gone sooo far downhill. I'm sure I won't be walking. Then my chances of having a less complicated surgery drops. All negative, when I should be saying " yippee " they didn't deny my claim. (If they had denied my claim, it would probably be easier to fight. Now there's no fighting the rules). Lizanne Pre-op forever > > I found out today that I have to go through 2 years of doctor > managed > > weight loss (diets) before I can be approved. I am so sad. I've > > been working on thsi is Jan 15, and now I find out all the rules > have > > just changed. > > > > I told my boss today that it would be at least two years before I > can > > have the surgery. His reply " Praise the Lord " . > > > > I can't stop crying. Sorry, I just had to tell someone. > > > > Lizanne Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 29, 2003 Report Share Posted August 29, 2003 The pits, That's not what my mind is saying, I'm glad this site is " G " rated because I feel like screaming. " pound buddies " I always thought they were flubletts. > That is the pits!!! Don't they know that the reason we are looking at this > surgery is because " diets " don't work for us. We might lose weight for a > while, but it creeps back on, usually bringing more little " pound buddies " > with it. Don't get discouraged. Hang in there. > > Charlotte > > Pre-op (tomistic) > > > > So Sad > > > > I found out today that I have to go through 2 years of doctor managed > weight loss (diets) before I can be approved. I am so sad. I've > been working on thsi is Jan 15, and now I find out all the rules have > just changed. > > I told my boss today that it would be at least two years before I can > have the surgery. His reply " Praise the Lord " . > > I can't stop crying. Sorry, I just had to tell someone. > > Lizanne > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 29, 2003 Report Share Posted August 29, 2003 There is a law office in California that is devoted to helping people get approval for surgery. You might want to check it out. His email address is: walter@... Hope this helps. Connie > I found out today that I have to go through 2 years of doctor managed > weight loss (diets) before I can be approved. I am so sad. I've > been working on thsi is Jan 15, and now I find out all the rules have > just changed. > > I told my boss today that it would be at least two years before I can > have the surgery. His reply " Praise the Lord " . > > I can't stop crying. Sorry, I just had to tell someone. > > Lizanne Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 29, 2003 Report Share Posted August 29, 2003 Lizanne, I have the same medical problems as you. I have arthritis in all my weight-bearing joints. My obesity aggravates my condition to the point of barely being able to walk. Because of this it is medically necessary to have WLS especially since it has been proven that all other diets don't work for the morbidly obese. Sure you would lose some weight but you'll just gain it back like always especially with physical limitations. I would fight the " rules " . Two more years of diet yo-yoing is not good for your body. I could understand maybe 6 months but 2 years is ridiculous. Some rules are to be broken. I say fight, fight, fight!!! Chris Preop 280/ /150 > > > I found out today that I have to go through 2 years of doctor > > managed > > > weight loss (diets) before I can be approved. I am so sad. I've > > > been working on thsi is Jan 15, and now I find out all the rules > > have > > > just changed. > > > > > > I told my boss today that it would be at least two years before I > > can > > > have the surgery. His reply " Praise the Lord " . > > > > > > I can't stop crying. Sorry, I just had to tell someone. > > > > > > Lizanne Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 29, 2003 Report Share Posted August 29, 2003 lizanne, don''t stop trying yet . Continue with the appeal process. It amazes me the different rules insurances come up with. My insurance wants me to have 3 years of medically supervised weight loss attempts. Where do they come up with these numbers? Like we haven't been dieting for years. Keep fighting. I have been denied 3 times and have now sent my appeal in to the state of MI.APPEAL APPEAL and APPEAL again if you need to. You are definitely not alone in your attempts for approval. Best of luck Jill 271/preop -- In Gastric_Bypass_Family , " lizanneflowers " wrote: > I found out today that I have to go through 2 years of doctor managed > weight loss (diets) before I can be approved. I am so sad. I've > been working on thsi is Jan 15, and now I find out all the rules have > just changed. > > I told my boss today that it would be at least two years before I can > have the surgery. His reply " Praise the Lord " . > > I can't stop crying. Sorry, I just had to tell someone. > > Lizanne Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 29, 2003 Report Share Posted August 29, 2003 Dear Lizanne, File an appeal and cite every single instance, going back as far as you can remember, listing every single medically supervised diet you've ever done. Unless the exclusion they are using says it has to be " two years medically supervised diet -- which is, by the way, outrageous in and of itself -- WITHIN THE PAST 36 MONTHS, or some such nonsense, maybe they will look at the years you've done it already and will approve you. If you would consider using a lawyer, I suggest Walter Lindstrom at obesitylaw.com -- he's a WLS patient and advocate and he's licensed to practice law in almost every state. I'm told his fee for the appeal is very reasonable, at about $350. You can e-mail him and write exactly what was written in your denial, together with the paragraph defining what your insurance company requires and he will, for no fee, tell you if your case is winable (my own word) or not. I wish you the best of luck and hope for a speedy reversal on this decision. Don't give up. Be proactive and fight for your rights. In the meantime, will your doctor (pcp) document any type of weightloss supervision for you since January. At least that would lop eight months off the 24 the insurance is requiring... It never hurts to ask. live each day like it's your last... love like you've never been hurt... Deb in Hazlet, NJ " Debbie Dancer " distal rny September 3, 2002 386/235/160 BMI 60/34.7/24 -151 -69.5 " Angel to Bill, Debbie (10/14/03) Ilene, Roy, and Ro Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 30, 2003 Report Share Posted August 30, 2003 Hi Lizanne, I assume you have Aetna? That's what I have, and it has the same requirements. Maybe you shouldn't give up so soon. Did you go to you PCP in the past to discuss weight loss? As far as I understand the requirments, it can be previous attempts to lose weight in the past that you discussed with your doctor. If you went to him and said you are on Weight Watchers, and he wrote that in your chart, that could count. Did you ever try phen-fen, Meridia, or any other prescribed drugs? My surgeon said all I should need for approval is 2 years of hand-written doctor notes discussing my attempts to lose weight. I am hoping that will suffice. I am at the waiting for approval stage, so I can't say for sure. I personally think the rule is ridiculously stupid. Why would you even TRY to lose weight in that circumstance, knowing if you succeed they will not pay for the surgey you need? I hope you can use some of this info. If not, you should at least be able to get the notes your PCP has since Jan. Don't give up! And as far as your boss goes, that is a terrible response. M Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 30, 2003 Report Share Posted August 30, 2003 Hi Lizanne, I assume you have Aetna? That's what I have, and it has the same requirements. Maybe you shouldn't give up so soon. Did you go to you PCP in the past to discuss weight loss? As far as I understand the requirments, it can be previous attempts to lose weight in the past that you discussed with your doctor. If you went to him and said you are on Weight Watchers, and he wrote that in your chart, that could count. Did you ever try phen-fen, Meridia, or any other prescribed drugs? My surgeon said all I should need for approval is 2 years of hand-written doctor notes discussing my attempts to lose weight. I am hoping that will suffice. I am at the waiting for approval stage, so I can't say for sure. I personally think the rule is ridiculously stupid. Why would you even TRY to lose weight in that circumstance, knowing if you succeed they will not pay for the surgey you need? I hope you can use some of this info. If not, you should at least be able to get the notes your PCP has since Jan. Don't give up! And as far as your boss goes, that is a terrible response. M Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 30, 2003 Report Share Posted August 30, 2003 Hi Lizanne, I assume you have Aetna? That's what I have, and it has the same requirements. Maybe you shouldn't give up so soon. Did you go to you PCP in the past to discuss weight loss? As far as I understand the requirments, it can be previous attempts to lose weight in the past that you discussed with your doctor. If you went to him and said you are on Weight Watchers, and he wrote that in your chart, that could count. Did you ever try phen-fen, Meridia, or any other prescribed drugs? My surgeon said all I should need for approval is 2 years of hand-written doctor notes discussing my attempts to lose weight. I am hoping that will suffice. I am at the waiting for approval stage, so I can't say for sure. I personally think the rule is ridiculously stupid. Why would you even TRY to lose weight in that circumstance, knowing if you succeed they will not pay for the surgey you need? I hope you can use some of this info. If not, you should at least be able to get the notes your PCP has since Jan. Don't give up! And as far as your boss goes, that is a terrible response. M Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 30, 2003 Report Share Posted August 30, 2003 Deb, I was so upset yesterday I don't even remember what I wrote. I am seeing my PCP on Wed. I have actually been keeping a food diary since Nov 2001 (don't ask me why, I don't know). He has only been my doctor for 2 years-September, because my company changed health insurance companies then and I had to find a new doctor because my old one didn't accept Kaiser Select. He believes that I need this operation, and has had 3 other patients who have had the surgery and it has worked out well for them. I'm just hoping that somehow he can construe this food diary as a supervised diet and then the two years can end in Nov 2003. I'm hoping, but it probably won't work. My question is...this isn't really a denial. They won't even review my case for acceptance until I satisfy this requirement. Has anyone tried to get the rules changed and won? Without a denial, I thought that there was no where for me to go. Thanks for all the caring, suggestions and sympathy. It was greatly appreciated from all of you who supported me when I was just sick of this mess. Lizanne pre-op (notice, I haven't given up yet) > Dear Lizanne, > > File an appeal and cite every single instance, going back as far as you can > remember, listing every single medically supervised diet you've ever done. > Unless the exclusion they are using says it has to be " two years medically > supervised diet -- which is, by the way, outrageous in and of itself -- > WITHIN THE PAST 36 MONTHS, or some such nonsense, maybe they will look at > the years you've done it already and will approve you. If you would > consider using a lawyer, I suggest Walter Lindstrom at obesitylaw.com -- > he's a WLS patient and advocate and he's licensed to practice law in almost > every state. I'm told his fee for the appeal is very reasonable, at about > $350. You can e-mail him and write exactly what was written in your denial, > together with the paragraph defining what your insurance company requires > and he will, for no fee, tell you if your case is winable (my own word) or > not. I wish you the best of luck and hope for a speedy reversal on this > decision. Don't give up. Be proactive and fight for your rights. In the > meantime, will your doctor (pcp) document any type of weightloss supervision > for you since January. At least that would lop eight months off the 24 the > insurance is requiring... It never hurts to ask. > > live each day like it's your last... love like you've never been hurt... > > Deb in Hazlet, NJ > " Debbie Dancer " > distal rny > September 3, 2002 > 386/235/160 > BMI 60/34.7/24 > -151 > -69.5 " > > Angel to Bill, Debbie (10/14/03) Ilene, Roy, and Ro Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 30, 2003 Report Share Posted August 30, 2003 Deb, I was so upset yesterday I don't even remember what I wrote. I am seeing my PCP on Wed. I have actually been keeping a food diary since Nov 2001 (don't ask me why, I don't know). He has only been my doctor for 2 years-September, because my company changed health insurance companies then and I had to find a new doctor because my old one didn't accept Kaiser Select. He believes that I need this operation, and has had 3 other patients who have had the surgery and it has worked out well for them. I'm just hoping that somehow he can construe this food diary as a supervised diet and then the two years can end in Nov 2003. I'm hoping, but it probably won't work. My question is...this isn't really a denial. They won't even review my case for acceptance until I satisfy this requirement. Has anyone tried to get the rules changed and won? Without a denial, I thought that there was no where for me to go. Thanks for all the caring, suggestions and sympathy. It was greatly appreciated from all of you who supported me when I was just sick of this mess. Lizanne pre-op (notice, I haven't given up yet) > Dear Lizanne, > > File an appeal and cite every single instance, going back as far as you can > remember, listing every single medically supervised diet you've ever done. > Unless the exclusion they are using says it has to be " two years medically > supervised diet -- which is, by the way, outrageous in and of itself -- > WITHIN THE PAST 36 MONTHS, or some such nonsense, maybe they will look at > the years you've done it already and will approve you. If you would > consider using a lawyer, I suggest Walter Lindstrom at obesitylaw.com -- > he's a WLS patient and advocate and he's licensed to practice law in almost > every state. I'm told his fee for the appeal is very reasonable, at about > $350. You can e-mail him and write exactly what was written in your denial, > together with the paragraph defining what your insurance company requires > and he will, for no fee, tell you if your case is winable (my own word) or > not. I wish you the best of luck and hope for a speedy reversal on this > decision. Don't give up. Be proactive and fight for your rights. In the > meantime, will your doctor (pcp) document any type of weightloss supervision > for you since January. At least that would lop eight months off the 24 the > insurance is requiring... It never hurts to ask. > > live each day like it's your last... love like you've never been hurt... > > Deb in Hazlet, NJ > " Debbie Dancer " > distal rny > September 3, 2002 > 386/235/160 > BMI 60/34.7/24 > -151 > -69.5 " > > Angel to Bill, Debbie (10/14/03) Ilene, Roy, and Ro Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 30, 2003 Report Share Posted August 30, 2003 Deb, I was so upset yesterday I don't even remember what I wrote. I am seeing my PCP on Wed. I have actually been keeping a food diary since Nov 2001 (don't ask me why, I don't know). He has only been my doctor for 2 years-September, because my company changed health insurance companies then and I had to find a new doctor because my old one didn't accept Kaiser Select. He believes that I need this operation, and has had 3 other patients who have had the surgery and it has worked out well for them. I'm just hoping that somehow he can construe this food diary as a supervised diet and then the two years can end in Nov 2003. I'm hoping, but it probably won't work. My question is...this isn't really a denial. They won't even review my case for acceptance until I satisfy this requirement. Has anyone tried to get the rules changed and won? Without a denial, I thought that there was no where for me to go. Thanks for all the caring, suggestions and sympathy. It was greatly appreciated from all of you who supported me when I was just sick of this mess. Lizanne pre-op (notice, I haven't given up yet) > Dear Lizanne, > > File an appeal and cite every single instance, going back as far as you can > remember, listing every single medically supervised diet you've ever done. > Unless the exclusion they are using says it has to be " two years medically > supervised diet -- which is, by the way, outrageous in and of itself -- > WITHIN THE PAST 36 MONTHS, or some such nonsense, maybe they will look at > the years you've done it already and will approve you. If you would > consider using a lawyer, I suggest Walter Lindstrom at obesitylaw.com -- > he's a WLS patient and advocate and he's licensed to practice law in almost > every state. I'm told his fee for the appeal is very reasonable, at about > $350. You can e-mail him and write exactly what was written in your denial, > together with the paragraph defining what your insurance company requires > and he will, for no fee, tell you if your case is winable (my own word) or > not. I wish you the best of luck and hope for a speedy reversal on this > decision. Don't give up. Be proactive and fight for your rights. In the > meantime, will your doctor (pcp) document any type of weightloss supervision > for you since January. At least that would lop eight months off the 24 the > insurance is requiring... It never hurts to ask. > > live each day like it's your last... love like you've never been hurt... > > Deb in Hazlet, NJ > " Debbie Dancer " > distal rny > September 3, 2002 > 386/235/160 > BMI 60/34.7/24 > -151 > -69.5 " > > Angel to Bill, Debbie (10/14/03) Ilene, Roy, and Ro Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 30, 2003 Report Share Posted August 30, 2003 Dear Lizanne, Then I would recommend you approach your doctor since he's been seeing you for almost two years anyway. Also again I suggest documenting all previous attempts (especially any where you did diet drugs such as phen-fen, etc.) because those certainly had to be under doctor's supervision. It is through this list that you make that you will be able to show them that you've met their criteria. You actually probably already meet the criteria if you combine all the dates that you've done this. I have NJ Plus Horizon Blue Cross Blue Shield and I know I had an easier time than most (Thank you G-d!) but they required a years worth of medically supervised dieting. I've been fat since I was 3 (and was 48 at the time of my surgery). My list was very basic, starting with being put on diet pills at age 8 by my pediatrician, going through WW, Craig, 20+ years in OA, diets requested and followed by my physician, etc. I did it in column format like this: Name/type of diet; date started; weight at start date; weight lost by end date of diet; weight gained back; Medically supervised (yes or no). My list was a page and a half long. It showed them a lifetime of dieting, sometimes being followed by a physician, sometimes not. That was good enough for them. Some insurance carriers are trying to make it more difficult by saying they want a medically supervised diet of at least six months within the past two years. If you can't document that type of thing, then you've got to start one now and know that there's a light at the end of the tunnel, but I would throw my list together first and send them a letter which states, " In compliance with your rule of having two years of medically supervised dieting, please read the following: " and be sure to highlight (or bold or italicize) every instance of medical supervision together with length of time of the diet. If you were supervised for three months 6 years ago and six months last year and five months 10 years ago, etc., that's 14 months right there. I don't believe it would have to be two years of consecutive dieting, but see if you can at least get that much out of them. Again, I wish you loads of luck. If I can be of any help, please don't hesitate to ask, okay? Be well. Deb > Deb, > > I was so upset yesterday I don't even remember what I wrote. I am > seeing my PCP on Wed. I have actually been keeping a food diary > since Nov 2001 (don't ask me why, I don't know). He has only been my > doctor for 2 years-September, because my company changed health > insurance companies then and I had to find a new doctor because my > old one didn't accept Kaiser Select. He believes that I need this > operation, and has had 3 other patients who have had the surgery and > it has worked out well for them. > > I'm just hoping that somehow he can construe this food diary as a > supervised diet and then the two years can end in Nov 2003. I'm > hoping, but it probably won't work. > > My question is...this isn't really a denial. They won't even review > my case for acceptance until I satisfy this requirement. Has anyone > tried to get the rules changed and won? Without a denial, I thought > that there was no where for me to go. > > Thanks for all the caring, suggestions and sympathy. It was greatly > appreciated from all of you who supported me when I was just sick of > this mess. > > Lizanne > pre-op (notice, I haven't given up yet) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 30, 2003 Report Share Posted August 30, 2003 Dear Lizanne, Then I would recommend you approach your doctor since he's been seeing you for almost two years anyway. Also again I suggest documenting all previous attempts (especially any where you did diet drugs such as phen-fen, etc.) because those certainly had to be under doctor's supervision. It is through this list that you make that you will be able to show them that you've met their criteria. You actually probably already meet the criteria if you combine all the dates that you've done this. I have NJ Plus Horizon Blue Cross Blue Shield and I know I had an easier time than most (Thank you G-d!) but they required a years worth of medically supervised dieting. I've been fat since I was 3 (and was 48 at the time of my surgery). My list was very basic, starting with being put on diet pills at age 8 by my pediatrician, going through WW, Craig, 20+ years in OA, diets requested and followed by my physician, etc. I did it in column format like this: Name/type of diet; date started; weight at start date; weight lost by end date of diet; weight gained back; Medically supervised (yes or no). My list was a page and a half long. It showed them a lifetime of dieting, sometimes being followed by a physician, sometimes not. That was good enough for them. Some insurance carriers are trying to make it more difficult by saying they want a medically supervised diet of at least six months within the past two years. If you can't document that type of thing, then you've got to start one now and know that there's a light at the end of the tunnel, but I would throw my list together first and send them a letter which states, " In compliance with your rule of having two years of medically supervised dieting, please read the following: " and be sure to highlight (or bold or italicize) every instance of medical supervision together with length of time of the diet. If you were supervised for three months 6 years ago and six months last year and five months 10 years ago, etc., that's 14 months right there. I don't believe it would have to be two years of consecutive dieting, but see if you can at least get that much out of them. Again, I wish you loads of luck. If I can be of any help, please don't hesitate to ask, okay? Be well. Deb > Deb, > > I was so upset yesterday I don't even remember what I wrote. I am > seeing my PCP on Wed. I have actually been keeping a food diary > since Nov 2001 (don't ask me why, I don't know). He has only been my > doctor for 2 years-September, because my company changed health > insurance companies then and I had to find a new doctor because my > old one didn't accept Kaiser Select. He believes that I need this > operation, and has had 3 other patients who have had the surgery and > it has worked out well for them. > > I'm just hoping that somehow he can construe this food diary as a > supervised diet and then the two years can end in Nov 2003. I'm > hoping, but it probably won't work. > > My question is...this isn't really a denial. They won't even review > my case for acceptance until I satisfy this requirement. Has anyone > tried to get the rules changed and won? Without a denial, I thought > that there was no where for me to go. > > Thanks for all the caring, suggestions and sympathy. It was greatly > appreciated from all of you who supported me when I was just sick of > this mess. > > Lizanne > pre-op (notice, I haven't given up yet) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 30, 2003 Report Share Posted August 30, 2003 Dear Lizanne, Then I would recommend you approach your doctor since he's been seeing you for almost two years anyway. Also again I suggest documenting all previous attempts (especially any where you did diet drugs such as phen-fen, etc.) because those certainly had to be under doctor's supervision. It is through this list that you make that you will be able to show them that you've met their criteria. You actually probably already meet the criteria if you combine all the dates that you've done this. I have NJ Plus Horizon Blue Cross Blue Shield and I know I had an easier time than most (Thank you G-d!) but they required a years worth of medically supervised dieting. I've been fat since I was 3 (and was 48 at the time of my surgery). My list was very basic, starting with being put on diet pills at age 8 by my pediatrician, going through WW, Craig, 20+ years in OA, diets requested and followed by my physician, etc. I did it in column format like this: Name/type of diet; date started; weight at start date; weight lost by end date of diet; weight gained back; Medically supervised (yes or no). My list was a page and a half long. It showed them a lifetime of dieting, sometimes being followed by a physician, sometimes not. That was good enough for them. Some insurance carriers are trying to make it more difficult by saying they want a medically supervised diet of at least six months within the past two years. If you can't document that type of thing, then you've got to start one now and know that there's a light at the end of the tunnel, but I would throw my list together first and send them a letter which states, " In compliance with your rule of having two years of medically supervised dieting, please read the following: " and be sure to highlight (or bold or italicize) every instance of medical supervision together with length of time of the diet. If you were supervised for three months 6 years ago and six months last year and five months 10 years ago, etc., that's 14 months right there. I don't believe it would have to be two years of consecutive dieting, but see if you can at least get that much out of them. Again, I wish you loads of luck. If I can be of any help, please don't hesitate to ask, okay? Be well. Deb > Deb, > > I was so upset yesterday I don't even remember what I wrote. I am > seeing my PCP on Wed. I have actually been keeping a food diary > since Nov 2001 (don't ask me why, I don't know). He has only been my > doctor for 2 years-September, because my company changed health > insurance companies then and I had to find a new doctor because my > old one didn't accept Kaiser Select. He believes that I need this > operation, and has had 3 other patients who have had the surgery and > it has worked out well for them. > > I'm just hoping that somehow he can construe this food diary as a > supervised diet and then the two years can end in Nov 2003. I'm > hoping, but it probably won't work. > > My question is...this isn't really a denial. They won't even review > my case for acceptance until I satisfy this requirement. Has anyone > tried to get the rules changed and won? Without a denial, I thought > that there was no where for me to go. > > Thanks for all the caring, suggestions and sympathy. It was greatly > appreciated from all of you who supported me when I was just sick of > this mess. > > Lizanne > pre-op (notice, I haven't given up yet) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 31, 2003 Report Share Posted August 31, 2003 oh lizanne - we are definitely in the same boat as far as health problems even though i think i have you beat by a few - i have BCBS PPO of Illinois and i'm not sure who you have but right now mine is " supposedly " in the appeal process located in a different city and they can't be contacted - what a load of crap - i just got my denial today and it is different on the one in back of the card so tomorrow i'm writing another letter and including a pic to see if that helps - the way i see it i can't hurt it -- when COBRA ends in march and i have to buy a policy you better believe it won't be BCBS if they don't do this surgery....i'm fuming.... visit our website www.geocities.com/tanyarn96/countryside.html -- So Sad > > > > I found out today that I have to go through 2 years of doctor managed > weight loss (diets) before I can be approved. I am so sad. I've > been working on thsi is Jan 15, and now I find out all the rules have > just changed. > > I told my boss today that it would be at least two years before I can > have the surgery. His reply " Praise the Lord " . > > I can't stop crying. Sorry, I just had to tell someone. > > Lizanne > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 31, 2003 Report Share Posted August 31, 2003 oh lizanne - we are definitely in the same boat as far as health problems even though i think i have you beat by a few - i have BCBS PPO of Illinois and i'm not sure who you have but right now mine is " supposedly " in the appeal process located in a different city and they can't be contacted - what a load of crap - i just got my denial today and it is different on the one in back of the card so tomorrow i'm writing another letter and including a pic to see if that helps - the way i see it i can't hurt it -- when COBRA ends in march and i have to buy a policy you better believe it won't be BCBS if they don't do this surgery....i'm fuming.... visit our website www.geocities.com/tanyarn96/countryside.html -- So Sad > > > > I found out today that I have to go through 2 years of doctor managed > weight loss (diets) before I can be approved. I am so sad. I've > been working on thsi is Jan 15, and now I find out all the rules have > just changed. > > I told my boss today that it would be at least two years before I can > have the surgery. His reply " Praise the Lord " . > > I can't stop crying. Sorry, I just had to tell someone. > > Lizanne > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 31, 2003 Report Share Posted August 31, 2003 oh lizanne - we are definitely in the same boat as far as health problems even though i think i have you beat by a few - i have BCBS PPO of Illinois and i'm not sure who you have but right now mine is " supposedly " in the appeal process located in a different city and they can't be contacted - what a load of crap - i just got my denial today and it is different on the one in back of the card so tomorrow i'm writing another letter and including a pic to see if that helps - the way i see it i can't hurt it -- when COBRA ends in march and i have to buy a policy you better believe it won't be BCBS if they don't do this surgery....i'm fuming.... visit our website www.geocities.com/tanyarn96/countryside.html -- So Sad > > > > I found out today that I have to go through 2 years of doctor managed > weight loss (diets) before I can be approved. I am so sad. I've > been working on thsi is Jan 15, and now I find out all the rules have > just changed. > > I told my boss today that it would be at least two years before I can > have the surgery. His reply " Praise the Lord " . > > I can't stop crying. Sorry, I just had to tell someone. > > Lizanne > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 31, 2003 Report Share Posted August 31, 2003 I have BCBS PPO as well and live in IL. What reason's did they give for your denial? I was fortunate they approved me in three day's. But my dh's employeer made an actuall clause specifing that they do cover the procedure without the psych clause or proof of diet. The only thing I had to have was a BMI above 40 or if it was lower then 2 comorbities. Did you get the number of the other city? I believe they have to state specific reason's for denial so hopefully they provided that so you are able to fight it. Good Luck, sorry it has been so difficult for you. Mel Open RnY May 2,2003 289/202/150 So Sad > > > > I found out today that I have to go through 2 years of doctor managed > weight loss (diets) before I can be approved. I am so sad. I've > been working on thsi is Jan 15, and now I find out all the rules have > just changed. > > I told my boss today that it would be at least two years before I can > have the surgery. His reply " Praise the Lord " . > > I can't stop crying. Sorry, I just had to tell someone. > > Lizanne > > > > > > > Quote Link to comment Share on other sites More sharing options...
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