Medically supervised vs. structured plan?

BigDreams · August 22, 2017

Hi! My very first appointment is next Wednesday and I've been reading everything I can about the different procedures. I already called my insurance company to find out the criteria for getting WLS and it appears I meet them all already!

My question: is there a difference between a medically supervised weight loss program and a structured weight loss program? I see people talking about their 6 month medically supervised diet, with weigh ins and nutritionist appointments. When I called my insurance company they told me that I just had to have done 6 months of a structured diet program any time in the last two years. Either 6 consecutive months or at least two 3 month periods. I was thinking that my stints with MyFitnessPal and exercise would count, but I'm not so sure. I know I can ask next week, but was wondering if anyone else had a requirement worded similarly.

Other than that, I'm thinking my approval process will go smoothly. I have a PPO through bcbs Maryland and it pays for everything, 100%. Yay!

strength.spirit.grace · August 26, 2017

Honestly, as far as insurance is concerned BOTH structured and medically supervised need to be-well-"medically supervised"....the wording is tricky, but all of the requirements, weigh-ins etc need to be documented or at least acknowledged by an MD, PA or RD. A structured weight reduction program is a commercial program like Weight Watchers, Jenny Craig or simply a diet plan from your PCP. A medically supervised weight reduction program is like a clinic or professional facility that is dedicated solely to clearance for bariatric surgery or non surgical weight loss. These clinics usually have rights to local hospitals or contract with other clinics for testing like sleep studies, endoscopies, and other required tests. I decided to go with the latter and just finished my 6 months. If you have the money, go with the professionals. They know exactly what is needed and set up every appointment for you. All you have to do is stick to their plan and they will work with your insurance requirements to ensure you have the best chance of getting an approval.

The requirements you're describing sound a lot like mine. I have Regence BCBS or Oregon but their surgical policy follows BCBS. Even if you don't have that insurance, take a look at their published medical guidelines. Just Google "Regence bariatric policy surg58 2017" and it will pull up EVERYTHING that insurance requires.

Hope this helps.