Question:
I need to know if having a history of medically supervised diets are a MUST
I have a BMI of 51.5, I do have arthritis in my hip, and both ankles, shortness of breath during the most minimum of activities, and chronic back pain, but I have not been on ANY medically supervised diets ever. Will this stop me from being approved? Since I have not had this, nor do I have high blood pressure,diabeties, or sleep apnea, do I even stand a chance of being approved? By the way,I have cigna PPO. I would appreciate any advice, I feel like throwing in the towel after months of research since learning of this stipulation. HELP! You can email me at [email protected], Thanks! — Glenna C. (posted on April 29, 2004)
April 29, 2004
Hopefully, somebody who has recently used the same insurance as you will
reply. However, I know that my insurance (Aetna) will deny you if you
don't meet their requirements, one of which is the supervised diet. If you
insurance requires this, they will likely deny if you can't document it.
The lack of co-morbidities shouldn't be a problem though as you meet the
BMI requirement of most insurances. Normally, co-morbidities only come
into play if your BMI is less than 40.
If your insuranc requires the diet, don't give up, just go to your PCP and
have him put you on a low cal diet and moniter you. He can also
"prescribe" exercise such as walking. Just make sure he puts it
in your records that he's doing this.
Have you done Weight Watchers, Jenny Craig or anything like that where they
weigh you? If so, some insurances will accept that as long as your PCP
puts it in your medical records that they are aware of you attending and
they are also monitering.
Don't give up...the fight is worth the prize in the end which is your good
health.
Good Luck
— Carolyn M.
April 29, 2004
contact your insurance carrier directly...ask what their requirments
are....
I know in my case, my surgeon was more concerned that I had tried every
avenue than my insurance company was..
if in doubt.. make an appointment with your PCP asap.. get started.. that
will get you on the road if indeed you are required.
Best of luck to you.
Peg Ly
lap rny 4/9/03
311/180/-131 25 pounds to goal
— Peg L
April 29, 2004
i had cigna and my bmi was barley a 37 and i was approved in 2 days but
they did want a supervised diet from what i have heard thats one of the
most imporant things to be approved.dont give up and good luck!!
nikki
— nikki C.
April 29, 2004
My insurance co. required that I have 12 months of supervised diets and I
had the documentation, but only after I decided to document it myself
(meaning I held onto receipts). I had tried weight loss products and
programs for 10 years before that, but who holds onto that info? NOt me. I
did not want a reminder of all my failures. In the end I went to Weight
Watchers, Physicians Weight Loss Center, and took Xenical & Meridian.
All were documented by my PCP and they approved me. My BMI was 43. Sadly
enough I had been on soooo many diets before those, but they were not
recognized. Unfortunately, until you have some sort of piece of paper with
your weight loss attempt info. on it they will give you a hard time. Good
LUck!
— Tara J.
April 30, 2004
Hello, I also have Cigna PPO. Was denied by Cigna in feb. for not having
the 26 week diet. I have a bmi of 40 with no other co-morb, expect what
the normal person who weighs 250lbs would. I called Cigna yesterday and
asked if I could appeal since I'm now into my 5th month, they advised not
to until the full 26wk is done. In my denial letter all it said was I
needed a 26wk. supervised diet from a doctor who doesn't perform wls and
show proof that my bmi has been over 35 for at least 1 yr. I'm now working
at getting all of my ducks in a row. I've also seen the dietaticain at the
hospital besides going to the doctor. Have I lost any weight?, no gained
approx. 5lbs. The doctor sts it is due to the muscle. Well I hope that
this helps, feel free to email me.
Sheila
— Sheila B.
April 30, 2004
Hello, I also have Cigna PPO. Was denied by Cigna in feb. for not having
the 26 week diet. I have a bmi of 40 with no other co-morb, expect what
the normal person who weighs 250lbs would. I called Cigna yesterday and
asked if I could appeal since I'm now into my 5th month, they advised not
to until the full 26wk is done. In my denial letter all it said was I
needed a 26wk. supervised diet from a doctor who doesn't perform wls and
show proof that my bmi has been over 35 for at least 1 yr. I'm now working
at getting all of my ducks in a row. I've also seen the dietaticain at the
hospital besides going to the doctor. Have I lost any weight?, no gained
approx. 5lbs. The doctor sts it is due to the muscle. Well I hope that
this helps, feel free to email me.
Sheila
— Sheila B.
April 30, 2004
Thank you to everyone that responded to my question!! I called cigna AGAIN
today, same answer, we are not sure, have dr. send a predetermination. What
kind of answer is that?? Anyway, I got my invitation to my first WLS
seminar today, :O) Looking forward to that! It is on May 18, and I am
seeing my pcp on May 4, so hope all goes well. Thanks again everyone!
— Glenna C.
Click Here to Return