Denied

So for the 2nd time I have been denied.  My insurance BCBSIL is saying that they need more information from my doctor supervised diet like a Journal of the food I ate during that time or the amount of exercise.   I'm so upset today.  This is the 2nd time I've gone through this.  In June I was denied for using Weigh****chers as 3 months of my supervised diet but insurance said I needed a doctor supervised diet so I did 3 extra months.  9 months later and still denied.   I guess I can appeal it after I receive the denial letter but man...I just feel so Defeated.  :(    ANy advise?

 Yeah I have them. They basically want you to go to a bariatric nutritionist. My weightloss center I went to was split into two parts. The left side was the surgeon and the right side was the nutritionist. They want specific documention from the nutritionist - basically bullcrap, but the nutritionist needs to be experienced on how to properly fill out the paperwork after each visit. Keep on fighting. Have you gotten the 6 months of nutritionist visits? 6 months is required and weigh****cher crap don't count. Is your nutritionist familiar with the insurance process?

Don't give up.  What is meant for you is for you.  Meditate and try again.  Speak to your doctor and see what he/she advises.  Good luck.

 I'm so sorry to hear your frustration!  Your doctor should know what BCLS needs in terms of documentation and be able to guide you in gathering that documentation.  If he/she didn't tell you exactly what you would need for documentaiton, I'd go to someone who's better informed about pre-surgery requirements.

She,

I was denied this week too.  I am so upset!  It is terrible that our futures have to be in someone elses hands.  I just want to be happy and energized and not exhausted ALL the time!  My surgeon is going to do a peer to peer with the medical director of the insurance company on Monday.  Have you tried that?  Hopefully it will work!!!  Good luck and DON'T GIVE UP!!!!! 

Dig up a copy of their policy bulletin on WLS and follow it as closely and as specifically as you can. I had to do this with Aetna - same intent (delay) but probably slightly different weasel words. They didn't state specifically that followup had to be monthly, just routine and regular - I shot for monthly with my PCP as the MD supervisor but scheduling, holidays, etc conspired to make it more on the order of every 6 weeks, and that was OK (with them, at that time....) I had a couple of nut consults (one of which was a year or so prior, but in the records,) but most importantly (AFAIK) was that I documented all of my efforts that were then included in the physician's records. My daily dietary intake logs (I use Nutribase, but there are several online free loggers that probably do a satisfactory job; a handwritten log is probably acceptable, but you should get into the habit of logging your intake anyway) and exercise records (the YMCA uses a computer logger called Fitlinxx that records weights lifted, reps, time on treadmills, crosstrainers, etc. and your entries for other exercise - swimming, walking, hiking, etc. - again, a handwritten log is probably acceptable, but a printout looks much more official.) I was coordinating with the surgeon's insurance coordinator and he was somewhat disappointed that the PCP didn't enter much commentary in his records such as 'advised patient to eat more of this and less of that, try this exercise...' and was concerned that Aetna would deny on that basis, but the approval flew through quickly (now if they would only pay up....)

If your surgeon has an insurance coordinator who is savvy in the ways of insurance approvals (hopefully he does,) work with them to understand exactly what is required. See if you can salvage any of the time and effort spent so far, regroup and try again.

Good luck with it all - we all know that it is a PITA, but persevere.

I had a friend suggest that I call the insurance myself and find out exactly what they want to see to make sure nothing gets lost in translation. The surgeon's office strongly suggested the same thing. They went so far as to say sometimes the patient gets better information than the doctor's office.

I have a different insurance, but I have already been prequaled to go and I don't even see the Do****il 11/10.

Just a suggestion, call yourself get every thing detail you need to make sure 3 is a charm.

Good luck.

I say dont give in hopefuly your surgen has experience he should do a peer to peer.

Sorry to hear the bad news. Maybe it is time to think about self paying. I am going to go that route. I don't want to jump through the hoops only to be denied. I also would like to do it on my own terms and when I chose, not by what someone in an office dictates to me. It is tough, but I there are lots of different ways to suppliment the money.

Good luck to you.

 Don't give up!  I was denied 3 times!  Finally got approval and was "sleeved" on 9/1/11