Question
What is the name of your state? NEW JERSEY
HEALTH NET HAS DENIED FOR LACK OF 6 MONTHS PCP NOTES OF DIETING.
ALL OTHER CRITERIA MEET MANY TIMES OVER. BEEN DIETING FOR TO MANY YEARS TO REMEMBER. ALL INVOLVED FEEL THIS IS THE RIGHT MEDICAL TREATMENT FOR ME. ANY IDEAS
Answer
yes wait until you get 6 months of notes from your PCP concerning dieting.
Sometimes you can't change the rules, you just have to follow them to get what you want.
Answer
What is the name of your state? NEW JERSEY
HEALTH NET HAS DENIED FOR LACK OF 6 MONTHS PCP NOTES OF DIETING.
ALL OTHER CRITERIA MEET MANY TIMES OVER. BEEN DIETING FOR TO MANY YEARS TO REMEMBER. ALL INVOLVED FEEL THIS IS THE RIGHT MEDICAL TREATMENT FOR ME. ANY IDEAS
Yes, but you're not going to like them.
1. Use a pencil and push that "shift lock" key over on the left side of your keyboard.
2. Duct tape mouth.
3. In 6 months, reapply.
Good luck.
Answer
Yes, but you're not going to like them.
1. Use a pencil and push that "shift lock" key over on the left side of your keyboard.
2. Duct tape mouth.
3. In 6 months, reapply.
Good luck.
YOU are Guilty -- number 2 is a bit rude and out of line. I agree with 1 and 3 though. As for OP -- go to your doctor and diet. Your doctor should weigh you once a month and show your progress or lack thereof. Then in six months reapply. There is no way around this. You also will need to meet all other criteria which may include a psych test, sleep apnea test, diagnoses of any and all other health problems, and clearance for surgery.
Do not argue about it. JUST DO IT!
Answer
How in the world is it rude? The poster obviously wasn't able to complete 6 months of dieting already (or else this post wouldn't exist). Therefore, in an effort to help complete the required 6 months, I offered a simple solution that doesn't rely on willpower. If anything, I was too polite. There are plenty of legimately "rude" suggestions I could have offered.
Answer
How in the world is it rude? The poster obviously wasn't able to complete 6 months of dieting already (or else this post wouldn't exist). Therefore, in an effort to help complete the required 6 months, I offered a simple solution that doesn't rely on willpower. If anything, I was too polite. There are plenty of legimately "rude" suggestions I could have offered.
Actually insurance company requirements for the dieting portion want to see doctor supervised dieting. Going to weight watchers or TOPS or dieting at home -- even if for longer times -- doesn't suffice. So she might have done the 6 months of dieting already. However they want to see doctor's notes throughout the six months of dieting that state specifically that the individual was on a doctor supervised diet and her weights throughout those times.
But duct tape? Granted it is not the rudest suggestion but it is rude.
Answer
But duct tape? Granted it is not the rudest suggestion but it is rude.
You ain't seen nuthin' yet, sister!
Answer
Actually insurance company requirements for the dieting portion want to see doctor supervised dieting. Going to weight watchers or TOPS or dieting at home -- even if for longer times -- doesn't suffice. So she might have done the 6 months of dieting already. However they want to see doctor's notes throughout the six months of dieting that state specifically that the individual was on a doctor supervised diet and her weights throughout those times.
But duct tape? Granted it is not the rudest suggestion but it is rude.
There are valid medical uses of duct tape and crazy glue.
Answer
There are valid medical uses of duct tape and crazy glue.
i am familiar with medical reasons for crazy glue but duct tape?
And you are guilty -- not trying to start a fight. Just disagreeing with your number 2.
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i am familiar with medical reasons for crazy glue but duct tape?
And you are guilty -- not trying to start a fight. Just disagreeing with your number 2.
It is used in dermatology to treat warts and the like.
Answer
It is used in dermatology to treat warts and the like.
Interesting!
Answer
YOU are Guilty -- number 2 is a bit rude and out of line. I agree with 1 and 3 though. As for OP -- go to your doctor and diet. Your doctor should weigh you once a month and show your progress or lack thereof. Then in six months reapply. There is no way around this. You also will need to meet all other criteria which may include a psych test, sleep apnea test, diagnoses of any and all other health problems, and clearance for surgery.
Do not argue about it. JUST DO IT!
See, I took that totally differently. When I read "duct tape mouth" I thought You Are Guilty just meant "Keep your mouth shut" as in stop complianing about this rule and comply with it then reapply.
Plus, if the OP wants the surgery he/she wouldn't want to lose weight beforehand cause then insurance will say "you can lose the weight on your own w/o surgery". The insurance company just wants to know that you tried unsuccessfully to diet for 6 months under a doctors supervision.
Answer
Plus, if the OP wants the surgery he/she wouldn't want to lose weight beforehand cause then insurance will say "you can lose the weight on your own w/o surgery". The insurance company just wants to know that you tried unsuccessfully to diet for 6 months under a doctors supervision.
What your are saying is logical, but it assumes the insurer is out to deny legitimate claims. The real reasons are:
Diet regulation and portion control are vital to succesful bariatirc surgeury. Developing an ability to do this is vital to success. Demonstraing this is what the insurer is after.
Additionally, the thinner you are at the time of the procedure the better the outcomes and fewer complication. A pre-surgical loss of 10% of weight is commonly required. Further, a maximum size is permisible for the laporoscopic procedure. If the patient is close to that size, the doctors will want them to lose that much weight to avoid the risks of the open procedure.
Answer
What your are saying is logical, but it assumes the insurer is out to deny legitimate claims. The real reasons are:
Diet regulation and portion control are vital to succesful bariatirc surgeury. Developing an ability to do this is vital to success. Demonstraing this is what the insurer is after.
Additionally, the thinner you are at the time of the procedure the better the outcomes and fewer complication. A pre-surgical loss of 10% of weight is commonly required. Further, a maximum size is permisible for the laporoscopic procedure. If the patient is close to that size, the doctors will want them to lose that much weight to avoid the risks of the open procedure.
Agreed 90%. Some insurance companies deny everyone first time through but will later agree on appeal. Sounds strange but there are many stories about this that I have seen personally. Also obesityhelp.com, [email]ossg@yahoogroups.com[/email] and various other sites are full of insurance stories with this surgery.
The other thing is that even if someone can lose weight on a diet it will not be anywhere near enough normally for them to fall below the required threshold for this surgery -- most insurers require at least at 40 BMI if not more though medical guidelines state at least a 35 BMI with co-morbidities.
I do agree though that the person complaining just needs to jump through the hoops. Some people are denied outright because their insurance doesn't cover it at all. This denial is easily remedied.
Answer
What your are saying is logical, but it assumes the insurer is out to deny legitimate claims. The real reasons are:
Diet regulation and portion control are vital to succesful bariatirc surgeury. Developing an ability to do this is vital to success. Demonstraing this is what the insurer is after.
Additionally, the thinner you are at the time of the procedure the better the outcomes and fewer complication. A pre-surgical loss of 10% of weight is commonly required. Further, a maximum size is permisible for the laporoscopic procedure. If the patient is close to that size, the doctors will want them to lose that much weight to avoid the risks of the open procedure.
Thanks for your comments, I'll admit I was talking out of my a$$ when I made my comments about what the insurance company wanted.