Need help making sense of this...Insurance Requirements Changed

[GADeltaDawn 14]

So I just got notified that my insurance requirements were updated last week to the following:

"The individual must have serially documented active participation in a non-surgical weight reduction regimen for at least 6 continuous months, in the 2 years prior to surgery, to enable both behavioral changes and adequate assessment of anticipated postoperative dietary maintenance. These efforts must be fully appraised and documented by the physician requesting authorization for surgery."

The prior wording was this:

"The individual must have actively participated in non0-surgical methods of weight reduction; these efforts must be fully appraised by the physician requesting authorization for surgery."

The requirements were pretty vague before but I'm trying to figure out if this is going to require a doctor supervised diet for 6 months or do they just want my personal journal of attempts over the past 2 years? Anyone else have this kind of requirement that can help shed some light on what they want? If they will accept my own journals, I want to have time to compile them before my appointment so my doctor can actually read them. But getting a straight answer from the insurance company is proving to be a challenge. They only want to tell the surgeon what my coverage is (not sure why, this is a battle I'm in the process of picking). I have Anthem BcBs.

Also, my PCP had prescribed me Wellbutrin in hopes that it would help with weightloss on top of managing my work stress level at the time. It did wonders for my stress so I have continued taking it but nothing for the weightloss. Do you think the insurance would recognize this as a medical weightloss attempt? I know I'm probably stretching here but I really don't want to wait another 6 months to do yet another diet that will fail.

I have my first appointment with my surgeon on Feb. 5th and I'm trying to get all my paperwork and records in order. Please help me to make sense of this!

Many thanks in advance!

[myra71 1]

All you have to do is go to your primary for six consecutive months and have them document your attempts at weightloss. Your surgeons office can let you know what wording is required to get approval. All my doctor wrote was I exercise 3 days a week and have making various attempts to loose weight either but cutting carbs, no soda etc and it was sufficient and by the way I didn't loose one pound during the six months. It seems to be a formality.

[Grrrrrrr really? 20]

I know every insurance is a little different. I was required to have a 6 month documented period of medical supervision. It was required that I had a Dr appointment once each month. I also had to have written, detailed, daily food and exercise diary for the whole 6 months. It was also required that I showed and maintained a weight loss. Didn't matter how much as long as I didn't gain it back. I also had to have a document from my Dr stating that he had worked with me on weight loss for those 6 months. I wasn't aware they would need the food diaries. Thank goodness I used an app called My Fitness Pal. It saved my butt! I was able to go back and fill out days I had missed and print them off.

No matter what the requirements are you can do this! If this is truly the right course for you and you are committed, You can get through it! Don't be discouraged! Your Bariatric surgeon's office will be able to help you figure out the details of the requirements and help you fulfill them!

[JustBeth13 35]

Having trouble understanding all this. I'm at the verrrrrryyyyyy beginning of this journey - not even had a doc appt yet.

My insurance (BCBS Federal Employee) requires 3 months doc-supervised diet prior to surgery. Just don't get the reasoning. If I COULD lose weight dieting, I would have already. So are they trying to prove that I really CAN'T lose weight or do I need to actually lose weight in those 3 months (which sort of proves i don't need surgery to lose weight).

Sorry for rambling, but I'm confused by this!!

[wannaBthinsoon 1,634]

I am almost certain the 6 months pcp supervised diet is strictly to observe whether or not you will go to appointments as scheduled. It didn't matter at all whether I lost or gained. Only that I went.

[newbeginings85 28]

Currently approaching my 2nd month of my supervised diet with PCP. My insurance bcbs sc requires me to have 6 months. My surgeons office said I'm not required to lose a certain amount ,I just can't weigh more at my last appt then I did at the first. Stick in there! It's tough when you have these hurdles to jump through but it also gives you time to research and start making the life style changes you will need to be successful in the long haul.

[geekguy 27]

My PCP actually offered to do this for me if the insurance required. My bariatric surgeon also offers a medical weight loss program for those who want to take that route, and for those whose insurance requires it. They use it as preparation for the WLS. You might check with the surgeon's practice to see what they offer.