Should I Be Doin More

[lanaekili 0]

I looked into my insurance requirements for the sleeve. I have been seeing my pcp for the 6 month supervised diet. I made the appointment to see the nut doctor. And I been goin to the gym. I feel like I'm missing something. This is what they want. Patient selection criteria for bariatric surgery include (NHLBI, 1998):

Documentation of a motivated attempt of weight loss through a structured diet program, prior to bariatric surgery, which includes physician or other health care provider notes and/or diet or weight loss logs from a structured weight loss program for a minimum of 6 months. Active participation in an integrated clinical program that involves guidance on diet, physical activity and behavioral and social support prior to and after the surgery. Psychological evaluation to rule out major mental health disorders which would contraindicate surgery and determine patient compliance with post-operative follow-up care and dietary guidelines.

[Lissa 2,631]

From what I've seen others post, the 6 month diet is required to be documented by your doctor/nut and they must note EVERY month that you were there for a consultation about your diet and exercise goals and results.

You might want to post who your insurance carrier is so that others who have gone through that carrier's program can help. Also, contact the bariatric surgeon that you have chosen and see if their office can help you navigate the insurance hoops.

Good luck!!

[lanaekili 0]

Thanks.. I have uhc oxford freedom plan..

[Shellyac 22]

You should see if your insurance company requires a certain BMI to qualify for the sleeve. I know that BCBS currently requires a BMI of 50 or higher. If your insurance company does have a BMI requirement for the sleeve and you don't meet it, I would suggest that you include the most recent position statement from the ASMBS (www.asmbs,org) about the sleeve when you submit to your insurance company for approval. The reason that BCBS, and I assume other insurance companies, require a BMI of 50 or higher is based on the previous ASMBS statement on the sleeve that only recommended it only for high BMI's. The new statement came out in October of this year so it's very likely that the insurance companies haven't updated their policies yet

[lanaekili 0]

I did look into that and it can be 35 with co-morbidities or 40 without

[Misstxdiva 73]

Have you contacted your insurance company bariatric department? They would be able to give you the low down. I am switching from Aetna to UHC Choice Plus in Jan and UHC is going to be assigning me a case manager. They said the case manager will be the one to tell me everything I need to know. Also my suregon's office has been really helpful. They were able to tell me what the requirements were and everything. I find that with the info I find online isn't always the case based off of the people I talked to with my type of insurance. Some cases are different where they require certain things of others.

[lanaekili 0]

I will be calling them to see about the case manager. I called them and asked about what I needed to do and they said I needed the six month supervised diet and the nut doctor and I could do the six months with my pcp. That I didn't have to be month to month but I go every month anyway. That was it. I just feel like I should be doin more.

[Misstxdiva 73]

Oh ok I get what you are saying. I know for me besides the diet. I have to see the nutrition every visit. Do my labs, EKG, and chest xray and a psych evaluation. I don't have to lose any weight while on the 4 month plan.