Question:
How much do I provide my insurance on the 1st try?
My insurance (Aetna) requires 5 years of medical records & proof of 6 mos. of Dr. supervised diets - I have both. However, I have the fear of being denied because I only have a few less severe co-morbidities and have not been MORBIDLY obese for a full five years. BUT, I ALSO have my Primary care docs. letter, documentation from Weight Watchers & an exercise program, handouts on calorie counting and menus from my doctor and more. I'm wondering whether to go with the "hit them with everything I've got" strategy and turn in everything when requesting approval, or should I give them the "bare bones" requirements on the initial approval request and save some ammunition in case I'm denied and need to appeal and provide more information. What has been your strategy?? Thanks! — Carly H. (posted on September 9, 2003)
September 9, 2003
What is your surgeon going to turn in? He is the one that should be
turning your insurance approval in along with a letter of medical
necessity.
— Delores S.
September 9, 2003
Yes, my surgeon's office will submit the request for approval and
everything required up front. Maybe they can advise me whether to
"hold back" on some of the "extras" I have. Thanks for
responding. I'd welcome other comments, too.
— Carly H.
September 9, 2003
I found out exactly what the criteria was, and hit them with both barrells.
You don't need to include the calorie handouts and such, but anything from
your medical providers, plus your own typed out diet history is what I'd go
with. I made a chart with columns listing my age, beginning weight, type
of program, amount lost - and I had a different entry for every age from 12
to current. Since the diet has to be doctor supervised, the Weight
Watchers stuff doesn't really prove what they are looking for.
Good luck!
— bethybb
September 10, 2003
I have Aetna also, and since I have been thru this before with Humana (on
Exclusion w/company), I sent in everything I had ever heard of to send on
this site. I made a 10 page letter up with the help of GREAT info on Sharon
Brittains site. SHe also had a very long list of co-morbs, that I put in my
letter ( I had over 50 co-morbs), along with my family history, and I made
up a diet history chart. I had 5 letters from (OBGYN/Sleep apnea
DR/Cardiologist/ENT Dr/ and PCP. I also sent pictures that showed how big I
am, and explained on the back of them where picture was taken and explained
how this weight has affected my life - example: Had picture taken on summer
vacation when I was on a Dolphin Tour and the only seat on boat I could sit
on was a bench on the back left hand side of boat. I am waiting to see if I
get approved now. My bariatric surgeon was very impressed with all of my
info and said I served it up to him on a siver platter. I know I didn't do
all of this by myself- I got help from my AMOS buddies. Thanks everybody!!!
Oh I also sent in info that showed that I've had Sleep Apnea for over 10
yrs!! Hope this helps. Becky M.
— bufordslipstick
September 10, 2003
P.S. I forgot to add that be sure and check Aetna's site for qualifications
on WLS. Aetna's site has recently been updated that you have to be on a
diet for 6 mo, but can go in to see the bariatric surgeon after 3 mo for
consult and/or to get surgery approved. You just have to wait the entire 6
mo period before you can procede w/surgery. I think the Dr has to keep on
documenting in your chart that you are still on the diet, so they have info
proving this.
— bufordslipstick
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