Supervised WLS diet

nursenky9 · August 7, 2008

My ins. co received paperwork on 7/7/08. On 7/23/08 my surgeon contacted me and told me that the ins co said they could not use the first MDs note because it was over 2 yrs old. 6/26/06, or were I saw the counselors there after for the month for my diet counseling wt in etc. I would like to know what all do u have to have for the ins?

My ins is BCBS PPO Highmark, they say at least 6mo supervised WL diet for a cumulative of at least 6mo over the 2 yrs prior to surgery.

I had a copy of my ins policy and it says that it takes physician supervised or counselors, exercise that is working under the MD supervision.

They would not count the mo of LA wt loss or weight watchers that I was doing.

It appears they only want to look at diet supervision when the doc prescribes phentermine.

Any suggestions or has anyone encountered this?

I had 4 mo of MDs and diet pills they were ok. I submitted 3 mo of my PCP notes that had "concerned about wt" or "wt gain" the last was "re lapband" under the diagnosis had wt gain, wt gain, obesity for the plan she wrote: labs, increase exercise calorie restriction, on the second one she orderd synthroid (even though my thyroid level was in normal range) to exercise and watch calories, on the 3rd not it was to follow low fat diet and exercise.

Just hoping I don't get denied.

Any comments would be greatly appreciated!! I have been at this process for some time now.

Thanks, and good luck to everyone!!! :w00t:

toribug1 · August 8, 2008

I am just starting and I have Humana. I have to do 6 months seeing a Dr. every month, weigh in, etc. I can have any exercise program as long as the doctor has the records to go along with it. If you ask me a waste of my time, the Dr. time and money. My PCP won't consider lapband so any notes from her is out. I can call and get my records for the last 10yrs but I do not normally see her every month. I tried to do the pills with a doctor but they were making me sick and his staff was no help so I stopped going. From what I understand they want to know that you can lose some weight. BIG WASTE OF TIME...I have lost a lot of weight and then I gain it back again.If I was a success I wouldn't be doing this. I guess I won't get to be banded till at least March of 2009, seems like a long time of waiting.

Sherri4ever · August 13, 2008

I'm in the same boat. I first went to St. Francis Weight loss center in April to start this journey. I completed everything they required (minus the pre-op support group meetings which I am attending now.) The center sent my information to my insurance provider (BCBS-Chrysler) and they denied the surgery due to 6 months of supervised dieting. WW didn't count, I needed to see a dietian. So now, I've been to this dietian for 3 months and have three to go. I agree, it is a waste. I have to pay for each visit along with all my appointments at the center. My dietian has never had a weight issue and is convinced I don't need the surgury, I can do it myself..GRR.. Yeah, I've lost 14 lbs in 3 month and will probably continue to loose some more, but keeping it off is my problem, she even had the nerve to tell me if I failed to drop some pounds she would inform my insurance carrier that I wasn't committed.. :crying:

My family physician has now filled out a paper for me explain my need for the surgery. I don't have any health problems regarding my weight but I have a twin brother who has diabetes and high blood pressure! He had gastric bypass 2 years ago and no longer needs any meds!! I am hoping to avoid all these problems! If I am denied again, I'll be livid. But the center seems to think I should have no problem being approved after the 6 months dieting.. Time will tell.