Denied

All my paperwork was submitted to my ins. co. for pre-approval. I supposedly only needed a BMI over 35 with a co-morbidity which I have. I got my denial back from Horizon BC/BS of NJ and they want me to do 6 months of supervised doctor dieting which i haven't done. Conveniently my employer is switching ins. co. Jan. 1 08' so I won't have the time. I'm bummed out but will try in Jan. with the new ins.co. :angry

Why not go ahead and start your supervised diet? That way, if your new carrier also requires the 6 months, you're already halfway through instead of having to start from scratch in Jan.

That is my plan I agree with you it could be a requirement for the next insurance co. also....

I agree. Just start the diet plan now. Go to a weight watcher's meeting so you can 'officially' have your current weight recorded and go from there. Keep track of everything. Good Luck to you.

Does WW count or must I go to my DRs. office? Has anyone had experience with this? Thanks....

hi itsme

I also have Horizon BC/BS of NJ and I went to my first info seminar the beginning of the year and thats when I found out that most insurances require the 6 month doctor supervised dieting. I was upset that I had to wait 6 more months but I took this time to find a new doctor - my old one never weighed me in the 15 years that I had been seeing him - and get the ball rolling on the surgery. I can say the 6 months did go pretty fast and before I knew it it was over. During the 6 months I did go to my doctor once a month and we tried a few different things and of course nothing worked!!! I also went to another seminar just to get a feel for a few different surgeons - I am putting my life in this persons hands so I want to make sure that I am making the right decision on the surgeon I pick. My PCP also set me up with the phych consult and some other testing that alot of the insurances require. Yeah I was bummed that I had to wait the 6 months but for me I feel like it gave me more time to make the best decision and to get some stuff that is required out of the way. I have my consult with the surgeon I selected on Oct 17th and I am hoping that I have everything required at that time so that I dont have to wait any longer.

good luck on your journey and definitely get the 6 months started even though your insurance is changing many insurances require the 6 months so it cant hurt to start now!!

To be on the safe side, I would go to your Doctor first. It seems like almost all of the insurance companies are requiring medically supervised diet. Fortunately for me, I have about 20 months worth. If you're not sure, you can also call your insurance co. and ask what they specifically require. At least you'll be a few months into it when your insurance is changed.
Good luck!!!!
Jenn

I'd like to add to not only go to your doctor, but do it MONTHLY. EVERY month, do NOT miss a month. Make sure you discuss weight loss and what you are doing to try to lose weight. Some insurances will NOT accept a letter from your doctor regarding weight loss and attempts, they will only accept office notes and your attempts must be documented in each visit note.

You may not need that, but please dot your i's and cross your t's just in case.

My biggest worry is that when I go for my surgeon consult he will tell me I still need to do x, y and z for the insurance to cover me!!!!!