Insurance requires failing. What?

[Brenda Sherwood 64]

So I started the proscess like everyone else, needing dr supervised diet, tests, psych evails, blah blah blah. I got it all done and dr has supposedly submitted it (insurance says they dont have paperwork, dr says faxed it twice) but I wanted a full explanation as to what's required because dr is worried Ill get denied for reasons his other patients are being denied. I spent an hour on phone with insurance. They said that you have to be on dr supervised diet and fail to lose anything, showing surgery is required. My dr said i needed to lose 5 to 10 percent of my weight, so I been working hard and lost 23 lb. Im so confused and upset. I think they are trying to just add loopholes to not do surgeries. Dont lose weight...not serious about it...lose weight...can lose weight on own, no surgery needed. I want to cry

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[Christinamo7 4,041]

right because if you loose weight without surgery they think you do not need it. my insurance had the same thing. I met with my doctor for 3 months, she told me what I "should" eat, but the bottom line was I needed to not gain or loose very much at all. which was fairly easy for me.

[ShrinkingPeach 1,291]

I had Aetna (of course there are tons of Aetna plans) and I had to show a history of weight loss attempts without success. I got copies of my PCP notes from diet plans and pills I had tried with little to no success. The insurance company was asking to see that I wasn't able to do it on my own. The attempts had to be for a required amount of time consecutively.

You will get approved, just hang in there. You can also appeal if denied so don't give up!

I had Aetna (of course there are tons of Aetna plans) and I had to show a history of weight loss attempts without success. I got copies of my PCP notes from diet plans and pills I had tried with little to no success. The insurance company was asking to see that I wasn't able to do it on my own. The attempts had to be for a required amount of time consecutively.

You will get approved, just hang in there. You can also appeal if denied so don't give up!

I had Aetna (of course there are tons of Aetna plans) and I had to show a history of weight loss attempts without success. I got copies of my PCP notes from diet plans and pills I had tried with little to no success. The insurance company was asking to see that I wasn't able to do it on my own. The attempts had to be for a required amount of time consecutively.

You will get approved, just hang in there. You can also appeal if denied so don't give up!

[Bufflehead 6,358]

I had to fail for insurance coverage as well. That part wasn't hard -- I've been failing, hard, at weight loss all my life and knew exactly how to do it. Like Water off a duck's back!

You should meet with your surgeon's insurance coordinator to explain the requirement from your insurance. They should be able to accommodate you in terms of not meeting the surgeon's requirement while you are going through the insurance approval process.

I strongly recommend that you get what the insurance company person told you IN WRITING. Sometimes those insurance folks talk out of their behinds and just make stuff up. Get it in writing.

[sgc 538]

I think the whole idea of a supervised diet is a farce. What exactly does it prove to the insurance company on whether or not they should pay for your surgery? Luckily I'm large enough to have this supervised diet waived. The only time my size has gone in my favor.

[Pillar2butterfly 391]

Most insurance companies have their policies online now. Ask them for the link to the WLS portion. If not online, ask them for a copy of the policy on WLS. this is not something private that cannot be given to you. I got mine from online, but my doctor's office knew it very well already. I got approved with no issues at all.

[MIMISAN 404]

I had to have supervised dieting for 6 months, I lost over 30 pounds and had no problem getting approved by UMR.

I have lost the same 100 pounds for 40 years and it always sneaks back and brings a few friends. My reason for the sleeve was to have a backup for letting the carbs back in. I started at 324 and when I went in for surgery I was 278.

[Brenda Sherwood 64]

Thanks everyone for tge input and positve thoughts. It seems things are getting cleared up. Insurance company is mixing policys for their national and Nevada branches. Dr is still having me sign releases and start 10 day liquid tomorrow. Worst case scenario is I lose extra weight on liquid diet and get denied, best case scenario surgery in less than 2 weeks

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[FlabbyNat 72]

Good luck and keep us updated!! I'm crossing my fingers.

My doc only made me lose 10 pounds per insurance, and no gain.........I suceeded. I waited 5 months through all the checklist but it's worth the wait!! 1 year post surgery, and down 60 lbs, and feel so great now!!

[Lizardlady 90]

My insurance required me to be making "documented" attempts at weight loss for at least 6 months (I have doctors documents going back almost a decade) AND I had to have a history of being overweight (which obviously I do). I know some are required to have health problems related to being heavy along with having a BMI over 30 I believe but my BMI is high enough (even with the weight loss) that I am not required to have health problems even though I do. Now that I am on this path to having VSG, they haven't denied me for losing the 25 lbs that I have lost recently because they know even if I lost 50 lbs, I will probably end up gaining it back without the surgery.

Did he say why his other patients are being denied? Could it possibly be the Dr. and not the patients? Insurance companies can be difficult too. It could also be the surgeon you've picked out. My particular surgeon has an insurance coordinator that is known for getting the insurance companies to work with people so maybe try another surgeon if they do end up denying you. One way or another, if you need this surgery and they deny you, don't give up!

[Brenda Sherwood 64]

My insurance required me to be making "documented" attempts at weight loss for at least 6 months (I have doctors documents going back almost a decade) AND I had to have a history of being overweight (which obviously I do). I know some are required to have health problems related to being heavy along with having a BMI over 30 I believe but my BMI is high enough (even with the weight loss) that I am not required to have health problems even though I do. Now that I am on this path to having VSG, they haven't denied me for losing the 25 lbs that I have lost recently because they know even if I lost 50 lbs, I will probably end up gaining it back without the surgery.

Did he say why his other patients are being denied? Could it possibly be the Dr. and not the patients? Insurance companies can be difficult too. It could also be the surgeon you've picked out. My particular surgeon has an insurance coordinator that is known for getting the insurance companies to work with people so maybe try another surgeon if they do end up denying you. One way or another, if you need this surgery and they deny you, don't give up!

The issues with others being denied was that originally it was a 6 mo diet, then they changed it to 3. So people who were at 3 or more, they sent papers for. Then insurancr denied because there wasnt 6 mo. They are confused lol. So, my Dr assumed I would get denied too since Im on month 4

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[future Mrs 26]

I lost 24 pounds whole doing my 6 month visits and I got approved . Had mine the 14th

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