Question:
Do you have to have a 12 month supervised diet?

has anyone by passed this and still been approvedwe have the requirements but can't prove it on paper so we are trying to get approved on WLS being medicall necessary. Has anyone else been through this?    — gary B. (posted on August 13, 2001)

August 12, 2001
You might want to check with your insurer again. I know my insurance BCBS of NC has just revised the policy in July to state that they no longer require proof of physician supervised diets. Thank goodness because who does that? no one. hope this helps a little
   — Barbara M.

August 13, 2001
My insurance (BCBS of North Dakota) required a 3 or 4 month physician supervised diet before they would approve AND it had to be medically necessary. My doc just gave me a diabetic diet sheet and asked me to come in once a month during that time period for blood pressure and weighing. At the end of the specified time period, My physician and my surgeon sent letters in requesting the surgery and I was approved in one week.
   — Cindy H.

August 13, 2001
Aetna US Access did not require any proof of a medically supervised diet. I did list my diet history for the surgeon, but I'm not sure how (or if) this was used in the submission for surgery approval.
   — Gina E.

August 13, 2001
Hi, It depends on your insurance company. I have PacifiCare HMO Colorado, and they did not require a supervised diet history, Best Wishes!
   — Carey N.

September 19, 2001
BCBS HMO Illinois also requires "multi year physician supervised weight loss failure". I have just been denied due to this, but am appealing. They expect a minimum of 1 year on a program, and more than one program. This criteria is impossible to meet for most people. If this is again denied, I will dump this insurance and depend on my husband's only.
   — Patricia R.

January 18, 2002
I have run in to this problem with BC/BS HMO Illinois. Even though I have an extensive history of medically supervised and medically unsupervies diets, they require a 1 year diet with one of 'their' doctors. They claim that they will cover surgery of 'medically necessary', but the diet guidline of one year is just an excuse to turn down the medically necessary.
   — Kimberly B.

January 18, 2002
I had a similar situation. I tried to contact the weight loss program I had been on but the medical practice had changed and the records were more than ten years old so they had been destroyed. I couldn't get the doctor to reply to my voice mails much less write a letter for me. Anyway, I wrote my own letter describing the program in detail and sent it to the doctor at my current medical group's (hmo) preferred Weight Loss Program. I requested that she send a letter to the medical group requesting a waiver of the requirement based on diet history. I followed up a week later to be sure they go my letter and left a message. That day I got a call that they had faxed the requested exception letter to the HMO and it had been approved. SCORE! Hope this helps. Good luck.
   — Phil M.

February 26, 2002
2/26/2002 - I have Aetna HMO and they have changed their criteria. I was denied stating 'patient must have been treated with conventional therapies that have failed". I have been on numerous diets, used a clinical dietician and documents proving my methods, the same as a 'doctor' would recommend, and I was still denied. At a loss as what else I can do!!!
   — Julie M.

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