6 month weight loss program

[sarahredwood 3]

My insurance requires a minimum of 6 consecutive months of physical or non physical weight loss program. See excerpt from my instance policy below. Does anyone know if I could use My Fitness Pal to show 6+ mo the of weight loss? I have 6 consecutive months from about a year ago and lost about 20 pounds but have gained it back. I am 5’2 BMI 40.

I would like to do the surgery in early July but just started with my practice on February 3 and that puts 6 months at aug 3. I have a major work event in September and the timing doesn’t allow for surgery before the event. If I cannot do surgery in July I will have to wait till early October. :(

The document must include that the patient participated in a structured, professionally supervised (physician or non-physician) weight-loss program for a minimum of six consecutive months within the last four years prior to the recommendation for bariatric surgery.

[GradyCat 3,695]

MyFitnessPal doesn't count as a structured, professionally supervised weight loss program.

[VIN_IN_AL 55]

I have Blue Cross Blue Shield (BCBS), and the structured diet requirements it varies between the different carriers within the BCBS network.

I strongly suggest you get on the phone and call the customer service number listed in the back of your insurance card and request a copy of the "Medical Policy for Obesity and Morbid Obesity Surgery".

It took me several calls but I finally received a current copy and I was amazed at the "official" wording, it was much different from what I was told on-line from support forums such as this one and from what the coordinator at the surgeons office was telling me.

[sarahredwood 3]

Thanks all.

Vin, I called customer service and they sent me a one page fact sheet that outlined the paragraph i included above. The fact sheet seems like a summary of requirements. I will call them again and ask for the "Medical Policy for Obesity and Morbid Obesity Surgery” doc.

Have you heard of anyone having success getting their insurance to shave off a few weeks from the 6 month requirement?

Thanks!

[brwneyedgrl96 5]

Hi Sarah! I have UHC and I have been discussing my weight issues with my dr for years now. She is aware of my attempts and she has prescribed several different things. I didn’t have a solid 6 months consecutively with her, tho. I did, however, have it on my Noom account. I was told I could use this if my doctor approved and is aware of my attempts. My doctor filled out my form and signed off on it. It was faxed a few days ago, so I’m waiting to see if the insurance will approve that.

Best of luck to you!

[VIN_IN_AL 55]

Don’t you just love insurance companies?

The one-page fact sheet is a joke, what you want is the same document, the official policy document they send to providers. What you got is the fluffy not much detail customer document. It may take a few phone calls and some persistence on your part, but it will pay off. If the person you’re talking too at BCBS is not helpful, just hang up and call again until you get someone else.

Also make sure your calling the number on the back of the insurance card provided by your employer and if your employer is in one state and you work at another location in a different state, make sure you validate what plan your in since as I have mentioned before the pre-surgery requirements are different from each provider group.

Here is an example, my employer’s main offices are in Virginia and Maryland, I am employed at another office in Florida, yet I live in Alabama. Within the last 5 years my member plan has changed three times from BCBS of Florida, to BCBS of Alabama to where it is today as of January 1^st 2020. Not one of the pre-surgical policies are the same, some have more restrictions others have less, it VERY frustrating. The one thing that is common to all requirements is that you have to follow it “as written” 100%, any of the slightest deviations and your starting over.

[catwoman7 11,216]

mine had to be with a physician or a registered dietitian.

as far as shaving off a few weeks, a lot of insurance companies are real sticklers about the rules. But you can always ask yours.