LACK OF DOCUMENTED WEIGHT LOSS EFFORTS

It is one of the most common reasons insurance companies will deny surgery:  the claim a patient has not documented sufficient supervised weight loss efforts before seeking surgery. For some insurers, it’s a 3 month diet, exercise and behavior modification program, but there are plenty of insurers who insist on 6 months or more – AND – they deny you if you don’t meet some arbitrary weight loss goal like a 10% weight loss!

There are even times where patients actually do exactly what the insurance company asks for, but they are STILL DENIED because the payer finds some flaw such as the documentation isn’t supported by contemporaneous chart notes, or the supervising physician was your bariatric surgeon and the insurer says “that does not count.”

Does Your Denial Sound Similar?

“…weight management program for at least 6 months, which includes documentation of your weight, vital signs, activity and dietary program. After review of the information received, there were no vital signs documented other than your monthly weights….”

“…diet must be supervised by a physician unaffiliated with the bariatric surgeon and the facility…”

Our office specializes in these types of appeals, working to overturn the denial while, at the same time, helping you to meet their criteria just in case your appeal is unsuccessful.

601-C East Palomar Street #480 Chula Vista, California 91911 Tel - (619) 656-5251 Fax - (888) 992-1188