worried about approval by insurance

gumbo · 08-09-2008, 10:53 PM

The bariatric center I went to insists that my insurance requires a 6 mon medically supervised diet and probably won't get approval without it. My insurance says it is not required but if sent in, they would use it along with other documentation provided to determine if the LB is medically necessary. My BMI is 43 with several documented co morbidities, high blood pressure, high cholesterol, severe backpain. I feel I definitely meet the criteria without the supervised diet plan and hate to wait another 6 months but I would also hate to not be approved for the LB. I don't know what do do.. Please help.... thanks....

Emilie1 · 08-09-2008, 11:37 PM

My insurance also does not require a six month wait. Where in texas are you? Can you go to another Dr? What is your insurance? It is rare that you do not have to have the six month wait and that is probably why your dr. is telling you to do it they just are not use to seeing it not done.

cookienay · 08-09-2008, 11:42 PM

Gumbo, first of all congratulations on taking this step to better health.
Now on to your question... My advice would be to get a statement in writing that your ins. company does not require this 6 month supervised weight loss plan. Insurance companies are notorious for telling you different things at different times- they count on you giving up out of sheer frustration. After you get this statement, then your center can submit for approval. Most SWL centers are familiar with the various plans and what they cover, so I would not completely reject what they are telling you until you have this. Make notes of who you speak with every time and what they tell you. Best wishes in your endeavor!!!

gumbo · 08-09-2008, 11:56 PM

my insurance is federal BCBS

Froggi · 08-10-2008, 12:36 AM

I'd say to just go through the 6 month diet. I am in month 4 of mine and it has been so helpful and I have already lost 23 lbs. The time really does fly by quickly.

Luv2scuba · 08-10-2008, 07:14 AM

i have national bcbs plan and mine requires a six month supervised (weight watchers & jenny craig count) or 2 -3 month supervised within the past 2 years. The Dr's staff i have spoken to have a hard time beleiving me too. They say, "I know this is what you thought you heard". I have it in writing (email). I can't get an appt with my surgeon until November, so to be safe, i'm going to start a medically supervised diet with my pcp in sept. that way i'll have almost another 3 months just in case. I don't want anything to hold me up.

But i know what you're going thru. I'd get it in writing and give it to your surgeons office. And maybe start a supervised diet at the same time while you are waiting for appoval. Better to be safe than sorry.