Insurance Requirements - Medically Supervised Weight Loss Program

[Alkalinetrio262 6]

Hey Guys,

Thanks for taking the time to review my post. I'm a 30 year old male who is about 5'6" and 315 lbs. I have blue cross and blue shield of Alabama and recently completed all of my pre-surgery insurance requirements. I actually went to see my primary for my last monthly medically supervised weight loss program appojntment. My weight has been pretty consistent fluctuating between 311-315 over the past 6 months. My doctor recommended 30 minutes of exercise everyday and cutting my calories to 1,500 a day. During each checkup I was honest about walking my dogs more frequently and that I was trying to eat smaller meals but was having problems with the 1,500 calorie restriction. He just gave me the forms he filled out for the past 6 months and next to the question, "was the patient compliant with the diet?" he checked "no" on every one of the 6 forms. This form is specifically what blue cross requires and now I'm worried my surgery is going to be denied by insurance for non-compliance. I haven't been able to get any feedback from the bariatric surgeons office on this yet but am really worried that I'm going to have to start all over again. Not only that but I'm changing jobs soon and don't know if this will be covered under my new insurance. Has anyone gone through a similar experience and if so can you please tell me what happened with your insurance approval? Thank you all so much!!! I'm looking forward to starting a new life and hopefully my honesty will not have ruined my chance for surgery!!!

[SarahLovy 6]

Did you ask your dr why he checked no and if he understood the implications of it?

1500 calories is a serious restriction for long term pre-op- I am a woman with similar stats, and my calorie goal set by my dietician is 1800-2200 calories a day, and i have been losing about a pound a week for the last two months keeping my calories around there.

[Alkalinetrio262 6]

Hi Sarah,

Thanks for the reply. I haven't had a chance because he gave me the forms as he was walking out to reception and I didn't look at them until I got in the car. However, he made some small talk at the end of our appointment about how life changing this would be and that I would feel like a new man, so I'm not quite sure he understands or thinks this will cause insurance denial.

[Stephanie Stroup McIntosh 157]

At this point, you can only wait. If you get denied, you can write a letter to appeal the decision. I would consider working on that letter now. Even if you don't need it, it would be great to get your reasons to have the surgery nailed down. You will be able to look at that everyday after surgery and keep yourself on track.