TiffanyN

Insurance issues

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Hello everyone, 

I'm stuck. I was denied today. Initially, I was told that I only need five years of documentation of weight and BMI. This was also stated to my insurance coordinator in my doctors office. I actually have documented five different occasions where I spoke to someone from my insurance dept who told me all I needed was 5 years of weight and BMI. Well, now they are saying I need 6 months of supervision diet. I've been going through this process for 3 months, has anyone ever deal with this. Where the insurance company has told you one thing and then changed to another. Could I possibly have the 6 months waived due to incorrect info. Especially, since I have it in writing (on two separate occasions I use the chat app through my insurance provider website and they never said that I need a 6 month supervised diet). I also made two separate phone calls were the conversation was the same.

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23 minutes ago, TiffanyN said:

Hello everyone, 

I'm stuck. I was denied today. Initially, I was told that I only need five years of documentation of weight and BMI. This was also stated to my insurance coordinator in my doctors office. I actually have documented five different occasions where I spoke to someone from my insurance dept who told me all I needed was 5 years of weight and BMI. Well, now they are saying I need 6 months of supervision diet. I've been going through this process for 3 months, has anyone ever deal with this. Where the insurance company has told you one thing and then changed to another. Could I possibly have the 6 months waived due to incorrect info. Especially, since I have it in writing (on two separate occasions I use the chat app through my insurance provider website and they never said that I need a 6 month supervised diet). I also made two separate phone calls were the conversation was the same.

You should be able to get a hard-copy, real, printed on paper booklet from your HR department or your insurance company, listing your benefits. In that booklet it will say whether bariatric surgery is covered and also what the requirements are from the insurance company to get it. Whatever that booklet says is pretty much gospel.

The 6-month supervised diet sounds MUCH more common to me than the 5 years of history.

Let us know what happens!

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22 minutes ago, Michael_A said:

You should be able to get a hard-copy, real, printed on paper booklet from your HR department or your insurance company, listing your benefits. In that booklet it will say whether bariatric surgery is covered and also what the requirements are from the insurance company to get it. Whatever that booklet says is pretty much gospel.

The 6-month supervised diet sounds MUCH more common to me than the 5 years of history.

Let us know what happens!

@TiffanyN:

There was medical guidance from some of the medical societies that included a sentence about referral to a bariatric surgeon after 6 months of a supervised diet - as I recall dating from 2013 or 2014. I posted the guidance here (I found it rather easily on the internet) about a month or 6 weeks ago in response to a similar kind of posting from someone else. If you search my posts you'll find it, if you don't want to look on the internet yourself. Alas, to my recollection there was nothing about 5 years of history. My guess is the fact that you were told this multiple times ... will be trumped by the written guidelines from your HR Dept or insurance company as @Michael_A suggests.... but perhaps there is little or no harm in being indignant (but always professional) on the off chance someone will have a heart (and a brain) about this. Diet work 1% or less of the time, and WLS most of the time (80-90+% of people lose medically significant amounts of weight). 

It's kind of stupid to make people do the 6 month thing with a 99% chance of failure but it can be argued that if YOU were one of the 1% it would be safer (no surgical risk) as well as cheaper for the insurance company. I think it instead just discourages people. Hoping you are not discouraged if the 6 month thing holds. 

If you are held to the 6 month supervised diet rule, be methodical, cold-blooded, and utterly prepared so (if surgery is right for you) on day 6 months and 1 day you are approved and set to go. FYI @Michael_A who replied above has been on a liquid diet for 6 months and not had his surgery yet, so he understands your time plight. You will find lots of people here who have been around the block. Some of the Adults (people on the Forum who do not post as frequently as they did in the past, but keep us newbies from being Too Very Deeply Dumb but had surgery 2, 5, 10 years ago) have experienced even longer delays... as I recall some people had to fire their docs and find new ones and start the process over. ... and suggest you consider posting who your insurer is, so others lurking about on the Forum can be forewarned and ready in case they also get bad guidance. 

See if the 3 months you have been in the process can count towards your 6 months. If you have been dieting at all and seeing your doc that may meet the criteria for supervision. 

Be strong through all of this. Focus on the outcome you seek. Good luck! 

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