Insurance Required Diet

[chubsy 1]

Hi All. So i met with my PCP yeaterday and he was very supportive of my decision. I told him that my insurance requires at least 3 months of supervised diet an he said to just start logging my meals and weight. What i really want to know is how will the insurance co. Interpret the results of this diet? Should one really strive to loose as much weight as possible or is that a bad move? I am afraid the insurance co. (cigna) might take it as " hey he can loose on his own NOT APPROVED" should i just loose a few pounds? Just to prove i tried and it didnt work? I know that if i stick with a diet and exercise for 3months i will loose weight but my problem is staying the course . I want to make sure i do this perfect and not give them any chance to question the approval. I would appreciate any advice i can get. Thank you

[lassie 247]

It took me a year to get approved and during that time my insurance required I had to be on a six month nutrition regiment. My weight and BMI was just over the requirement for the insurance so after losing a little my insurance turned me down because I lost just enough not to be covered. It was a nightmare for me I had waited a year to be turned down. I was so depressed I gained weight and my doctor resubmitted my claim and I was approved. Go figure ( no pun intended. ) hehe

[chubsy 1]

Sorry to hear u had to go thru so much. I want to play this smart. This is a move by insurance to have the last option to denie you. They can interpret however they want and fits in their favor. I am not sure what to do.

[Sojourner 2,446]

No, this diet requirement is not a move by the insurance company to deny you approval for the procedure. Generally the medically supervised diet is to substantiate your claim that your repeated attempts at weight loss have not been successful or sustainable. You also need to show your level of commitment to adhering to a diet, and have this documented by your physician.

My PCP included in his letter of medical necessity that I had been his patient for 10 years, and during that time I had not been successful to both loose and maintain a lower weight. You need to show that you are not capable of maintaining the degree of weight loss necessary to improve your health.

You did not mention any weight related comorbidities you may have...these are also important to be stressed to the insurance company, as in the long run, they will save money if you are able to loose the weight which contributes to them. Though my BMI was "only" 38 when my letter of medically necessity was submitted, I was approved because of my 4 weight related comorbidities.

If you only have to do a 3 month diet, you are fortunate...mine was 6 months. I did loose some weight, but not enough to improve my comorbidity issues.

Best wishes...

[feb27bandwoman 112]

Be careful with Cigna. I have heard they are very strict and may require lots of " jumping through hoops"!!!!

[Jim1967 3,569]

I have Cigna and they've been great. I had to do 6 month monitored diet but it has changed since then to a 3 month. I had to go to the weight loss center every month and weigh in and I had to provide food journals and exercise logs. My Surgeons staff took care of compiling the data and faxed it over to Cigna. I was denied on day 3 after submittable because they had my birthday wrong and they were not provided food journals.

Very important to journal. Cigna will want a sample of the journal. I am not sure exactly how much was sent to them but I provided the center 3 months of logs.

After my birthdate was corrected and food journals were sent in I was approved on day 4 after the original submittable.

Cigna also covers my fill adjustments 100%. I don't even make a co-pay.

Like others have said the insurance company is not trying to punish you. They want to make sure you are committed to a life change.

[chubsy 1]

Thank you all.

@jim1976 did you actually diet during that time or you only kept a journal of what you ate whatever it was? I am still confused on whether i should try really hard to loose weight during that period or hold back some. Dies the unsurancr company expect you to actually diet and loose weight or hust to log your regular food intake???? Thank you

[Jim1967 3,569]

I had my seminar Sept 5, 2011. I had my first consult Oct 12, 2011 and that was the start date. My Center requires all patients to lose 5% of their weight. They also wanted to see commitment plus they need you to shrink your liver to ensure a safe and successful surgery. Liver is quite large and the Surgeon has to work around it and move it out of the way to properly place the band. On that same day (Oct 12) I saw the on staff Nutritionist and together we developed a diet plan to help me reach that 5% goal.

So from Oct 2011 to March 30, 2012 I dropped 38lbs. I exceeded the 5% which was 24lbs in the first 6 or 7 weeks. My Surgeon was extremely happy with my weight loss but was worried I would pack it all on before the surgery date was even made. He was opposed to Cigna's requirements because he felt 6 months was too long to make someone wait for Surgery. He felt in his experience most patients typically do well on a 3 month diet but begin to falter before hitting month 6. I promised him I would do my part to make this surgery a success.

I will admit I could have lost more during those 6 months but who can complain about 38lbs.

As for the insurance company they don't care if you lose or gain. They want to see that you've made attempts to lose the weight. Insurance company is not going to punish you for losing weight by denying you surgery approval. They want to make sure you are serious and truly invested in making a change.

I was told by my surgeon that they submit the highest weight to the insurance company so even if you lose that is the number the insurance company will use.

[chubsy 1]

Jim ( i am assuming it is ur name). Thanks much. I guess i will find out more about what the surgeon wants at the seminar. I hope it is the surgeons office that handles the 3 month dirt and not my pcp.