doingit

You guessed it, 6 month diet. I have done the following and do not know if I should push the submission to the insurance company after pysch eval. I have BCBS of Texas. They indicate that WW is acceptable. I have done the following this past year. 11/07 dr weigh in talked about surgery 12/07 wieght/BP check w/nurse and went to dietician 01/08 wieght/BP check w/nurse 03/08 joined WW and at same time had Dr complete medical necessity form for health care spending account reimbursement. On it he indicated obesity etc and need for lifetime ongoing commitment. Sill going to WW since then, so have a little over 10 months, but did not weigh in monthly with dr. 11/08,12/08 and 01/09 weigh in w/dr and he completed surgeons progress note form which proves we specifically discussed weightloss/modifications. Now by the time I get my Psych consult I will have 4 consecutive weigh ins w/progress note form. Insurance clerk is hesitant to send before an offical 6 months of completed progress notes. My opinion is then why does the insurance co state WW is acceptable but at the same time they expected me to visit the dr each month as well? would you wait the 2 more months for a greater chance of approval or move forward and take a chance that since he signed the medical necessity form he was approving that method of dieting? meet BMI/co-morbidities and 5 years. thanks sorry for so much detail but I hadn't came across any threads with this mixture.

Thanks for replying HeatherO and restlessmonkey!!! Well I got a suprise today. Was talking to a co-worker and she told me she had to meet with a nurse 7 times for one hour. I thought that was odd since I didnt see anything in the med policy about it, nor did the customer service rep mentioned it when I called to make sure WLS was not excluded. And sure enough I seen a glimpse of it under the provider section that lifestyle coaching program was required on top of meeting medical necessity. Glad I happened upon that so I can get started on those sessions as well!! As long as they are willing to try to meet weekly with me I will be fine, if they throw in a monthly schedule I will be very disappointed. Wouldn't you have thought this information should be in the medical policy or in the section of my certificate that states wls is covered if medically necessary??? :biggrin: