6 Month "Diet" Requirement

[nicole914 0]

I am at the beginning process of dealing with my insurance company. Their "diet" requirement seems a bit vague so I am wondering if you have the 6 month (or any other timed requirement) is it spelled out by your insurance company or is yours vague too?

Thank you!

[anna0323 0]

my insurance company also requires this 6 month diet. my doctor said that the reason is to see if you are really series about having this done. You need to try to loose weight and follow the 2 week pre-op diet by your doctor. You cannot weight more than you did when you first started this process with your doctor or they will refuse it. With that being said you should not try and kill yourself to loose 100lbs either. This 6 months is to help you get prepared for your new life after being banded.

[odizzydori 0]

Hello,

My insurance company required a 6mth diet as well. So my surgeon put me on the high Protein low carb diet. During the 6mth month I just visited his office, the nurtitionist, had the pshyc during that time. It went by really fast. But there was no guidelines except to be on a diet and show progress of some type. Good luck on your journey. I was banded April 21, 2008 and my scale this morning says I have now lost 87lbs.

[nicole914 0]

Did your insurance paperwork say that you need 6 Months or just past attempts?

[Jaculin412 0]

I have BC/BS of NJ and also have to do six month monitoring. My surgeon said I just need to go to my PCP once a month for six months, doesn't make a difference if I lose or not. During the visits my PCP must make notes of what was discussed such as behavior modifications I'm attempting, exercise I'm doing, any sort of dieting, any aches, pains, joint pain, or any other issues that affect me due to my weight. The sugeon told me the more detail the PCP writes the better for me and my PCP knows that, she has done this before for others. Once I'm done with the six months I will get those notes along with a letter of necessity from my PCP and all will be given to my surgeon who will then submit to my insurance along with other required test results. My six month is November and they scheduled my surgery for November 24th so I'm assuming they don't see approval being an issue. I'm 44, 5'3 and have a BMI of 46, I take meds for blood pressure and underactive thyroid.

[CHI-Girl 1]

mine is very vage as well doesn't say anything more then attempted to loose weight in the past. I did look at the BCBS of IL just to get a feel of a different one and it was spelled out 6 months all over that policy. I'm at the begging as well and I'm assuming that I don't need the 6 months either just showing some effort which I can provide for sure. I have BCBS of GA. So I think you will be able to beeze right through as I prob will as well.

Good luck keep me posted

[TQUAD64 9]

I have BC/BS and they required a 6-month pre-diet, which is either monitored by my PC doc or a nutrionist. Weigh ins are requires along with education, which all has to be documented. I chose to meet with the nurtionist, but my PC doc is in the loop as well.

I completed the entire process and I have an appointment to see the surgeon on October 8. I have requested that BC/BS provide me written documentation pertaining to my medical benefits, specifically bariatric surgery coverage. I am waiting for that written information.

[Froggi 4]

My insurance required a 6 month diet too. I goto the nutritionist 2 times a month for 6 months. My last appt is Friday then I send my paperwork in. The 6 months has gone by very quickly. I have lost 26.5 lbs on it. I didn't have to lose but I did. I am on a diet of between 1200-1600 calories a day and I need to exercise at least 30 minutes a day 5 days a week. No caffiene/carbination. On my preop when I start it I will have to lose at least 5 lbs.

[PATCHELTON 0]

I have Blue Choice (BC's HMO) and they also required a "documented 6 month weight loss attempt" and I used the dietician on the bariatric team. Met with her once for initial weigh-in, and discussion of healthy food choices. She told me they didn't care if I lost weight, I was just not to gain any during the six months. After that meeting I weighed myself every two weeks (I work in a doctor's office so I did it at work) and email her the weight. I didn't work very hard at losing, and I was honest about my weights, and managed to lose 10 pounds. They would also accept Weight Watchers, Nutrisystem, anything like that which was documented. You could use two different 3 month attempts even. Of course their customer service rep told me I would probably be denied and have to do the 6 month diet all over, because the dietician was out of network. He was wrong. Out of network just means out of pocket, at least in my case. The psych nurse and dietician were both out of network. I paid them and was approved.

I was put on a pre-op liquid diet and lost 25 on that. The rest has been post-op.

[Ditkadog1 0]

I have Health Alliance through the State of Illinois and it actually spells out the 6 month pre-op diet. I have to lose 5% of my total weight in 6 months in order for them to approve the surgery (obviously with all the other requirements that go along with that approval). For me that means losing about 12 pounds. That 12 pounds would also take me under the required BMI of 40, but they said that didn't matter because they go on your weight when you first start the process.

I am so glad to hear so many of you saying the 6 months pre-op go by quickly! I am scheduled to see my primary care doc tomorrow and start the journey to being healthy and thin! The quicker these next 6 months go by the happier I am going to be!!

[Jaculin412 0]

I am going to my PCP for my six month supervised (June-Nov) but also going to the nutritionist. I have seen my nutritionist only once so far but starting October (actually have an appt next week) I will see her twice a month. For me I feel she will be most important to me after the surgery. Good luck to everyone!!!

[mindwing 15]

I am just starting also, and my surgeon requires the 6 month diet. I don't think Medicare requires it, but it is still needed. :crying:

I actually have lost 25 pounds during the last 7 months, but I wasn't going to the doctor every month. I have mamaged to go see my pcp every month for the last three months, so I am hoping that fills the requirement.

The visit this month will be the one to request the surgery, I have a list of requred tests for the surgery, and hope to get most of them ordered by my pcp as soon as possible. Most of them need to be done anyhow, as it has been years since I had them. I am hoping some on the list won't be needed.:cursing:

I am currently drinking Protein shakes twice a day and having Soup for the third meal. My Snacks are the current issue, though most days they are yogurt or string cheese, or fresh fruit. Sometimes I have Cookies or candy, though. I am working through that and by the time I'm ready for the surgery I hope to have those gone also.:thumbup:

I am looking up great recipes to try- some real gourmet stuff. Good Soups and vegetable drinks. I plan on enjoying the small amount of food I will get to eat. It helps with the head hunger, too.:thumbdown:

mindwing:shades_smile:

Nothing tastes as good as thin feels.