For anyone in CA whos been told they need a 6 mo. doc. diet...

Nov 05, 2009

I have Blue Shield HMO.  If you live in California and had a denial requiring a 6 mo. diet, read this.  This is a post that I started when I got denied a referral by my medical group (not my insurance) for a consult with my surgeon.  I wrote an appeal letter and got it overturned with the help of another obesity help member who posted:
"In the state of CA you do not have to do the medically supervised diet. The supervised diet is just a hoop and stall tactic that IPA and insurance use to delay or prolong patients getting WLS. If you've already received your denial letter then appeal directly to your insurance now. They have 30 days to respond to your appeal. If they do not give you an answer to your appeal within the 30 days then on the 31st day call up the CA Dept. of Managed Health Care (DMHC) http://www.dmhc.ca.gov/ and file a grievance with them based on not getting the referral because of the 6 month supervised diet. If your insurance denies you too based on this criteria call up the DMHC and file a grievance when you receive that denial letter. The DMHC has a peer review on this very subject. Here is the link: include this in your appeal letter
http://www.dmhc.ca.gov/aboutTheDMHC/org/boards/cap/Bariatric REV.pdf 
Click on the link below to read the whole post.  I hope it helps someone else like it did me. 
The denial by my medical group for a referral to have a consult with my surgeon was overturned and approved by my insurance and then the surgery was submitted and approved by my insurance within weeks. 

http://www.obesityhelp.com/forums/amos/3866637/Denied-a-referral-for-not-having-6-mo-phys-doc-diet/#31044805

0 Comments