Has anyone gotten out of the Dr supervised diet?

TheLid · April 28, 2007

I have BCBS and they will cover my surgery, but they say that they want notes from the Dr showing at least 6 months of a supervised diet. Has anyone else gotten out of this? I have been on a lot of different diets, but I never went to my Dr and checked in with him. He has written a letter of medical necessity for the surgery, but will this be good enough? I would really like to not have to spend more money on unneccesary Dr visits and have to put off the one thing that will really help me keep the weight off. My weight is fluctuating between 287 and 300. At the rate I am going I will be over 300 if I have to wait.

Alexandra · April 28, 2007

Even though this sounds like a unreasonable hoop that your insurance is asking you to jump through, I think it makes a lot of sense. You can think of it as practice for the banded life, and if you're not successful at losing weight during this time that's nothing to worry about. The simple act of meeting with your doctor on a monthly or bi-weekly basis to talk about your behavior can really get a patient in the right frame of mind for surgery.

I don't know of any way or reason a carrier would simply waive that requirement. You just have to get started, and it will be over before you know it. Six months is nothing.

faithmd · April 28, 2007

I agree, six months is nothing. My insurance requires a twelve month MD supervised diet. It is just something that you have to do unless you have the resources to go to a surgeon and self-pay. I suggest if you do that, that you do some serious research about the doctor first. Some are wonderful, some are questionable, some are quacks. Also, you need to set up aftercare in your area BEFORE you go elsewhere and have a band placed. Just some things to take into account.

I am also here to tell you that six months means EVERY month. Do NOT miss ONE single monthly visit.

If you do not have the resources to self-pay or decide that the six month diet is doable, then start right away! Also you have to find out if your policy has a weight loss requirement during this six month program. If so, you need to make sure you loose that weight or you will be denied. I was, and that was despite letters from two doc's saying it wasn't my fault and that I was sick and on meds that precipitated my weight gain.

Good Luck!

Paula78 · April 28, 2007

Well I have BCBS of Kansas, and since I'm Type 1 diabetic I did not have to go through the 6 month or 1 year diet. It only took about 2 months to get an apporoval. (Which seemed like forever at the time.) I did have to go for a psych eval but that was it!

TheLid · May 1, 2007

I was told at the seminar that I would need a 6 month supervised diet, so I started worrying that I was going to have to put off my surgery. I am on kind of a time crunch since I am in nursing school year-round with only a 6 week break Aug-Sept, so I really wanted to get it done the first part of August. I don't know If I will even have this insurance next year.

I called the insurance again and they said that they do not need a supervised diet, they just need documentation that I have talked to my Dr about my weight issues over the years. I asked specifically if it had to be every month and she said, "No". I asked if a letter from my doctor stating that I have been working on this for over 10 years blah, blah, blah...would be good enough or if I had to have specific chart notes. She said, "No, the letter will be good enough." I was so happy to hear that!

My big question now is: What if the next person I talk to tells me something different? I have the Lady's name that I talked to, so can I hold them to it?

Also: Will going to a chiropractor for degenerative doint disease in my neck and lower back count as being treated for an "obesity related comorbidity"?

This is driving me crazy. I am a person that is very in to details. I have to know the answer to everything before I do anything big. I know I should just let my Drs office take care of all the insurance stuff, but I am a control freak.

Thanks for all of your advice.

Melissa S · May 1, 2007

TheLid... I'm waiting right along side of you on this one....

I have Empire BCBS of DE which only says the patient must have actively participated in non surgical methods of weight loss... here is the link:

http://www.empireblue.com/provider/noapplication/f2/s5/t9/pw_ad080419.pdf

The surgical coordinator told me it was to be a 6 month medically supervised diet..but that link comes directly from BCBS (sent to me by the customer service dept)...

My info was submitted to insurance Thursday... they sent medical records, a letter from my primary stating she is aware of my weight loss attempts as well as emails to and from her regarding diet, exercise and request for labwork... I also submit a payment record from the past year and a half of gym membership... hopefully that'll do.

reeburgdon · May 2, 2007

I have BCBS UT Select and prior to our new fiscal year (Sept 1st) they only required proof of at least 5 years MO. Now they also require a 6 month doctor supervised diet and there was no way around it, even with the letter of medical necessity. My co-worker who was banded prior to the 6 month rule just told me it was worth waiting 6 months to have them pay for the surgery in full and that they probably do it as a way of making people not want to jump through hoops which gets them out of having to pay for it. I didn't fall for that one, I just completed my last weigh-in and my paperwork was submitted to them on Friday, so now I'm just waiting.

nulife2be · May 6, 2007

Hello to you,

I alos have BCBS of Kansas and I have just started the process of the psyc and the diatician. I have my siminar on May 12th. I was not told that I would have to have a six month diet regulated by a phy. Who do I need to cotact to find out if this is needed for me? I am so scared that I will be denied for some reason. What can I do to make sure that I will get approved. I have borderline diabetes, asthma, sleep issues, acid reflux, lower back pain, joint pain and a BMI of 47. Please help with what I need to do to get appoved though insurance. I was going to have this procedure done x 2 years ago, but the insurance decided not to cover the procedure after I was getting ready to do it. I will do anything to have this surgery... I want my life back, and I want to live not only for me, but for my son....... Many thanks in advance......

faithmd · May 7, 2007

Hello to you,
I alos have BCBS of Kansas and I have just started the process of the psyc and the diatician. I have my siminar on May 12th. I was not told that I would have to have a six month diet regulated by a phy. Who do I need to cotact to find out if this is needed for me? I am so scared that I will be denied for some reason. What can I do to make sure that I will get approved. I have borderline diabetes, asthma, sleep issues, acid reflux, lower back pain, joint pain and a BMI of 47. Please help with what I need to do to get appoved though insurance. I was going to have this procedure done x 2 years ago, but the insurance decided not to cover the procedure after I was getting ready to do it. I will do anything to have this surgery... I want my life back, and I want to live not only for me, but for my son....... Many thanks in advance......

The only person who can tell you what your insurance policy requires is your insurance company. Call them tomorrow and ask what their requirements are to cover Adjustable Gastric Banding. Then ask that they snail mail you those requirements so that you have them in hand.