What documentation do I need to “prove” medically supervised weight loss for ChampVA?

[Matt P 4]

Hi everyone,

I’m helping my wife begin the process of preparing for gastric sleeve surgery.

We have ChampVA, and the people in the government bureaucracy (some of which are truly good people,) are incredibly ignorant.

No one can tell me what “documentation” I need to prove medically supervised weight loss.

Has ANYONE here succeeded in having ChampVA approve their bariatric surgery, and if so, how EXACTLY did you document your proof of medically supervised weight loss?

I don’t have any papers from my wife’s docs that state anything SPECIFIC about her failed diets, only that the docs recommended weight loss attempts, and her weight just went up and down due to health problems.

I don’t want my wife to be denied for surgery because it’s her only viable chance for weight loss!

Her BMI is 40, she has high blood pressure, has one knee surgery, can’t exercise, has PCOS, chronic pain and fatigue, takes meds for depression and anxiety (for YEARS,) and has tried various diets with no success for 20 years.

I love her to death, but I know if she has to jump through hoops for 6 months “medically supervised” to fail at another diet, it’s just gonna crush her emotionally.

So if anyone here HAS succeeded in getting ChampVA to approve their surgery, I’m begging you to PLEASE reply or message me!

Thank you, and God bless.

[Sosewsue61 3,185]

Medically supervised says it all, she has to see a doctor and/or a nutritionist and they have to put her on a medically supervised diet that fails. She might need to maintain a certain bmi - like 40 or some plans say 35 - 40 with comorbidities. I can't know what the policy says you must be to qualify for consideration. PCOS would not be comorbidity but high blood pressure, sleep apnea would be two that usually are. My policy said i could lose weight but not gain any during the 6 months. I had to also keep a walking journal to prove commitment. Your policy should be online and you can get answers via email by asking very specific questions rather than random oral inquiries. Ask - what Medically Supervised, does that mean a physician, nurse practioner, nutritionist. Do I have to fail completely or if i lose weight does that disqualify me, do I have to maintain s certain bmi, what comorbidities qualify, do I have to keep a food journal, do I have to have 6 appointments exactly one month apart, if I gain am i disqualified, etc. They have to answer written questions. Good luck.

[RickM 1,747]

There should be a policy bulletin on the insurance company's website that spells out exactly what is needed for WLS, and that is your bible. Your surgeon's insurance coordinator may be able to help with this as well, as they live and breathe this stuff and know what it really says.

Typically there is often a requirement for three or six months of "medically supervised" diet and exercise, or weight loss effort, supervised by some kind of medical professional MD, RD, etc., and sometimes a commercial program such as Weight Watchers is acceptable. I used my PCP as my supervisor and at each meeting gave him the printouts from my diet tracking and my exercise tracking and he included that in his notes. Usually they want weight noted and often some kind of words about diet counseling or discussion.

The insurance may also want some kind of documentation of past weight loss efforts - some do, some don't - which can be receipts or notes from Weight Watchers, etc., doctor notes about loss effort, weight loss med prescriptions, etc.

[Matt P 4]

Thank you very much for the reply!

It is worth asking the insurance company for specifics. But sadly, anyone who has dealt with government bureaucracies knows, often times the right hand doesn’t know what the left is doing.

I get my medical care at the VA, and the amount of incompetence/ignorance is staggering. After getting an MRI done, I was told I had to give it to one department, then let THAT department give it to a specialist, then that specialist would review it, then THEY would contact my primary care provider who would direct me to someone ELSE to see a physical therapist.... I took my MRI results paperwork/CD to the Release of Information department where they told me this convoluted process. I asked, “Can’t I just hand this stuff to the receptionist at X department?”. He replied, “No. this is a PROCESS; besides, they won’t just accept your paperwork anyway.” I asked the turn around time. He said “Two weeks.”

Guess what I did? Took my paperwork up to the 2nd floor, handed it to the secretary, and got a call back the NEXT DAY to complete the process of my care.

THIS is what government healthcare and ChampVA is like— complete ignorance and blind adherence to an outdated and inefficient process.

The reason I asked for any personal experiences people have had with ChampVA, is to perhaps duplicate their SUCCESSFULL attempts at the documentation process.

I do truly appreciate the replies though!

[Matt P 4]

Just NOW read your reply Rick; thanks.

The problem is that my wife has 20 years of experience with failed diets, but we saw no reason to notate /document these failures. The doctors also have no official mention of these circumstances in their notes, only vague and generic comments like, “patient advised to undertake nutrition plan,” “patient unsuccessful in losing weight.”

So there’s nothing that LOOKS like a perfectly linear and “organized recounting” of her failed attempts.

ugh, it’s gonna crush her to see a doc for six months straight and fail on another diet.

Just makes me sick.

Then she may just get so depressed and say that she can’t deal with it, and dump the surgery plan altogether.

[Amnico 1]

I’m curious if anyone has any updates on getting covered they champVA and what all is technically needed?

[MrsE 4]

Hi! I have CHAMPVA and I am currently in the process for approval. I need to finish 6 months of required nutritional guidance classes, lab work, exams and psychological assessment. In June I see the Surgeon with my completed checklist and from there I shall see what happens... hoping for the best!!!

[ahillig 136]

My doc just said that I need to come in, get weighed, and talk about nutrition. For my first visit she put that I stopped drinking pop and energy drinks and started eating more grilled chicken vs fried chicken. Next time it'll be that I cut down on sodium as that's what we identified to work on for the next visit.