Interpretation of my policy..

[_Brooke_ 45]

Hey all! So I am very new to this and had my first doctors appointment for the 6 month weight loss plan required by insurance. Below is an excerpt from my bcbs of al policy. I'm confused by the items in ( ).. it says including dietitian consultation. Does that mean I have to go to a dietitian once month or just once? I want to make sure to do this all correctly. Thanks!

Documentation of participation in a physician supervised program of nutrition

and increased physical activity (including dietitian consultation, low calorie

diet, increased physical activity and behavioral modification).

[Daisee68 2,493]

I would agree that is a bit vague, but by being "supervised" I would bet it is more than just one appt. I have Cigna and they specifically require 4 visits with a dietician over a span of 90 days with at least 30 days in between each appt.

[chubbsey1 126]

Usually means once a month and depending on which BCBS you have it can be anywhere between 3 & 6 months. For example I have BCBS through Emblem health in Ny and it was 3 months worth of weigh ins @ my surgeons office. Good luck!

[_Brooke_ 45]

Thank you! I just don't want to not go enough and get denied. Last time I called Blue Cross Blue Shield all they did was read the policy. They wouldn't elaborate.

[_Brooke_ 45]

This is the entire paragraph. Which doesn't tell me how many times I have to go to dietitian. Idk why they make things so complicated.

Documentation of participation in a physician supervised program of nutrition

and increased physical activity (including dietitian consultation, low calorie

diet, increased physical activity and behavioral modification). Documentation

of program participation must appear in the medical record no less than

monthly for a period of 6 consecutive months by the attending physician.

Documentation should include comments by the physician regarding patient

progress or lack of progress. A letter does not meet this requirement. There

must be medical records to document medically supervised weight loss

attempts;

[Daisee68 2,493]

It is not written very well but it does so monthly for 6 months documented which I think is referring to your dietician visits.

[_Brooke_ 45]

Thank you! I guess what I will do is make 2 monthly appointments. One for primary care physician and one for dietitian.

[anaxila 501]

My interpretation is that want to have a copy of your medical chart, and that your medical chart must include a note on your progress each month for six months straight. I do not interpret it to say that you need to visit the dietician every month, just that dietician consult should be part of the overall plan you're following. Given how specific they are about "for a period of 6 consecutive months by the attending physician.", I would think that they would say "for a period of 6 consecutive months by the supervising dietitian" if that's what they wanted.

[Daisee68 2,493]

Have you met with a surgeon yet? A lot of times their office is very skilled at reading these requirements and will help you make sure they meet all of them.

[_Brooke_ 45]

@ anaxila thank you. I will call my insurance company again to see if maybe they will be more specific. What you said is what I was thinking it meant just wasn't sure.

[_Brooke_ 45]

@@Daisee68 I called the surgeons office to see what I am supposed to do. They said that I had to complete my 6 months before I met with the surgeon at all. Also I would have to go to a seminar first and then a lady would go over everything and make an appointment with the surgeon but that I had to do my 6 months first. I have been reading other people's post and they met with the surgeon first. So I don't understand why my surgeon wants me to do the other first.

[starbuckscoffeegal 36]

You just have to talk to your PCP at each visit that includes those things and they have to notate in your chart. Yours is similar to the Aetna ins I have. I just got approved last month. Surgery scheduled for February 25. Six months will fly by, I promise.

[_Brooke_ 45]

@@starbuckscoffeegal

Congratulations! I bet you are excited to be starting this new journey in your life!

[lmblakes 17]

I also have BCBS and while everyone's is different I went to the free seminar, gave them my insurance information and then a few weeks later ( that part did take a bit) they then had a list of everything I needed to do, the number of NUT visits, different labs, etc. I recommend going to the seminar, it could answer a lot of your questions. Best of luck!

[_Brooke_ 45]

Thank you! They told me that I had to do my 6 months first but I am going to call tomorrow and make sure that's right. At the very least hopefully they can tell me exactly what I need to be doing. Insurance companies pride themselves on being difficult. Lol