first letter sent and denied... - ThinnerTimes

marybeth · 03-01-2006, 09:46 PM

I had a response within a few days but it was denied. They said that I have never tried a medically supervised weightloss clinic. So they are telling me I'm denied and I'm thinking if I go to this supervised weightloss clinic then perhaps they will approve me. But tomorrow morning I do not know who to call, the surgeon's office? , to see what I do now. I know I can appeal it, it mentions that on the back of the letter but I feel I need to speak to someone for advise....Thanks for any advice., Marybeth

forsythia · 03-02-2006, 02:16 AM

I had to do 6 months of a medically supervised diet as well. You can ask your surgeon, your PCP, or your insurance company's customer service reps for more details - they all might know. You basically need to find out what kind of medically supervised diets will qualify.

My surgeon's office offers a diet program (it uses specially provided food) but it was very expensive (thousands of dollars). My insurance company required it but wouldn't cover it. Optifast was another option , but was also too expensive for me.

In the end, my PCP and I worked out a diet plan that would met the insurance company's requirements. It used regular food so I only had to pay her for the monthly visits when I went to weigh in. The bonus was that they were covered by the insurance company as regular office visits.

If this would meet your insurance company's requirements for the diet (and money is an issue - I don't know if it is for you), maybe you can work that out with your PCP. Good luck!

Brooke220 · 03-02-2006, 05:29 AM

I just saw my PCP on a monthly basis for 6 months (make sure you don't miss one month) where he took lots of notes about what I had been eating and if I'd been able to exercise; of course, they also weighed me and tested my blood sugar (I'm diabetic or I was until after my surgery

); in addition, I went to Weight Watchers (the nutritional consult). I'd ask them if you can do this through your PCP.

marybeth · 03-02-2006, 10:09 PM

Quote:

Originally Posted by forsythia

I had to do 6 months of a medically supervised diet as well. You can ask your surgeon, your PCP, or your insurance company's customer service reps for more details - they all might know. You basically need to find out what kind of medically supervised diets will qualify.

My surgeon's office offers a diet program (it uses specially provided food) but it was very expensive (thousands of dollars). My insurance company required it but wouldn't cover it. Optifast was another option , but was also too expensive for me.

In the end, my PCP and I worked out a diet plan that would met the insurance company's requirements. It used regular food so I only had to pay her for the monthly visits when I went to weigh in. The bonus was that they were covered by the insurance company as regular office visits.

If this would meet your insurance company's requirements for the diet (and money is an issue - I don't know if it is for you), maybe you can work that out with your PCP. Good luck!

Thanks for all the info, I appreciate it. Marybeth

marybeth · 03-02-2006, 10:10 PM

Quote:

Originally Posted by Brooke220

I just saw my PCP on a monthly basis for 6 months (make sure you don't miss one month) where he took lots of notes about what I had been eating and if I'd been able to exercise; of course, they also weighed me and tested my blood sugar (I'm diabetic or I was until after my surgery

); in addition, I went to Weight Watchers (the nutritional consult). I'd ask them if you can do this through your PCP.

Brooke, that may be a possibility thanks for the idea, Marybeth