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Hello-- Question about insurance terms : )



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Hello everyone. I am new to the forums. I'm happy to meet you all! I have a question. I asked my insurance rep what it meant- but he said my actual insurance company was very "vague" in the term and he encouraged me to basically grab whatever info I could from my PCP regarding past weight-related visits, just to basically have the theme of "weight" documented past visits.

The term I am referring to is, while my insurance does not require me to go on a 6 month diet or anything like that, it does say it requires "Documented failed medical weight loss history"

I asked my insurance rep if that entails failed diets "created" by my doctor, or if it included weight-related visits-- going to the doctor to discuss losing weight, going home and doing it, failing, etc. Basically, the specifics of the term. The rep told me what will likely happen is, with the info I can gather from weight related visits from my PCP, is that my insurance will either approve me (yay!) and it'll stop there, or if they deny me, whoever does the denials and responsible for giving the reason- will then be more specific about what it entails. Its a bit of a headache as I don't feel my insurance should be so vague in the first place so I know for sure : (

So I guess what I'm asking is, to possible people who had a similar criteria, or the exact same one preferably, what did it entail?

I have Independence Blue Cross, based in PA.

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I have a different insurance company, but mine meant I had to talk in detail to my nutritionist about all the diets I had been on. I talked about dieting since I was 12 years old. They also want you to mention that you tried weight watchers and failed. No one asked me for proof of all the diets I had done. I would not have been able to prove it as I didn't know I would need to produce the receipts.

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I have a different insurance company, but mine meant I had to talk in detail to my nutritionist about all the diets I had been on. I talked about dieting since I was 12 years old. They also want you to mention that you tried weight watchers and failed. No one asked me for proof of all the diets I had done. I would not have been able to prove it as I didn't know I would need to produce the receipts.

Thank you so much! I appreciate the response. Right, it is quite weird to provide infallible proof of all the diets you've ever been on- for me, its not something I ever wanted to remember LOL, so there's no way outside of my doctor visits that I ever kept proof of my diets.

I wonder why Weight Watchers in particular that they asked for? To me, a diet is a diet, regardless of the way you mentally look at it which is essentially what Weight Watchers does- gives you a "refreshed" way to look at dieting.

Thanks so much for your response!

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Harmonia - wondering how you made out with Independence BCBS. Hubby and I are both going for VSG, but I have not had a regular PCP until June of this year. I have Jenny Craig documentation, and am working on documentation from a nurse supervised program we did at a fitness center. We have started nutrition counseling, and all of the specialist consults we have to have. Curious how you (or anyone) made with with Independence BCBS documentation. Did you get approval? How long did it take? Thanks!

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    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
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    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
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      1. summerseeker

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