What do you think - 6 months with PCP

[Lady Lap Band 71]

I went to the Doctors in November, it was technically for a sick visit because of my cronic headaches but we discussed my weight as being one of the problems and they weighed me at 250. They also set me an appointment with a Nutrionist that very day. At the time I did not have a PCP and just saw another General Internal Medicine Doctor.

I have a physical appointment with my new PCP on 12/31 and at that time plan to tell her of my lap band plan.

I know I am going to have to do a 6 month PCP diet and weigh in, but my question is...do you think that my appointment in November and my one in December will count as 2 months or do you think my one in December will be counted as number one? Or perhaps neither will count?

I am just so eagar to get the ball rolling and am really hoping that at least one of these visits will count?

What do you think? Oh and please tell me about your experience if you had to go through a 6 month PCP diet.

THANK YOU!

[BeautyLocs 0]

Hi Breanne--

Have you talked with your insurance company yet? The documentation from your 6-month plan has to be pretty specific, so it would be a good idea for you to get a written statement from your carrier about what they need documented during your medically supervised program.

I opted to enroll in a weight loss program that was designed for my insurance company. I met one or more times a month with a nutritionist and an exercise physiologist. I also met with a wellness counselor (social worker), but not monthly. They documented my weight, my exercise, my calorie intake, my challenges and behavioral changes.

According to the policy I received from my insurance company about bariatric surgery, this should satisfy them. Now, I did gain weight on my supervised program so I don't know yet whether or not I'll be approved. You should definitely ask if losing is a requirement and if so how much.

I hope that helps. Good luck to you!

[Band_Groupie 3]

Like they said- ask your insurance. For me I have to do 7 visits with my PCP (6 mo. + initial weigh in) and they have to be soley about my diet/exercise program (can not be combined with sick visit). I was told the visits get coded to the insurance co. and a sick visit is coded differently than a weigh-in visit (so your sick visit wouldn't have counted for me, or even the second one if you didn't use a form to collect the data). At ea. of these 7 visits a form is used for you and the PCP to take notes (surgeon's offices will give you theirs to use). Has stuff like weight of course but exercise plan/min. is just as important as well as education about the LB. I also had 2 months of "false starts" because I didn't know exactly what was needed. Go to your insurance and attend seminars first.

[Lady Lap Band 71]

Like they said- ask your insurance. For me I have to do 7 visits with my PCP (6 mo. + initial weigh in) and they have to be soley about my diet/exercise program (can not be combined with sick visit). I was told the visits get coded to the insurance co. and a sick visit is coded differently than a weigh-in visit (so your sick visit wouldn't have counted for me, or even the second one if you didn't use a form to collect the data). At ea. of these 7 visits a form is used for you and the PCP to take notes (surgeon's offices will give you theirs to use). Has stuff like weight of course but exercise plan/min. is just as important as well as education about the LB. I also had 2 months of "false starts" because I didn't know exactly what was needed. Go to your insurance and attend seminars first.

That definetly all makes perfect sense. I am sure that the insurance company will be specific. I will call the weigh loss center tomorrow and ask them to help me get started. I am seeing a new PCP for a physical on 12/31 and hopefully I can work out something to get it to be my first one. Thanks again!

[Band_Groupie 3]

Breanne- Just in case you don't get a form before your physical (ask for full bloodwork as you might find additional comorbidities like high cholesterol or diabetes you don't know about and that will be helpful in getting coverage for LB), here's a copy of mine (just posted this for someone else). I don't think they'll care if you use a different one to start as long as all the info. is captured. Tell your PCP the visit needs to be a weight visit for insurance purposes. Good luck with the headaches also...I just started meds. for chronic Migraines a few months ago and it's been wonderful relief! Here's my post/form:

I created my own combining the info./templates of the 3 hospital seminars I attended, and had it approved by the insurance expert at my surgeon's office (below- I condensed the lines/format). I was told insurance wants to see monthly goals for both weight (I was told not to gain, but not to lose much either, I'm on a step down calorie program-American Fare plan) and exercise every month (as important as the weight), the Dr. visits must not be about anything other than this (that's how they code the visit for insurance-so don't combine it with a sick visit-someone on LBT was denied for it being a sick visit just one month.), and they also want to see some form of education is going on. I told my PCP I could initiate the topics (ie. last month I took in a family history list of all the obesity related issues in my family history-actually an eye-opener for me when I put it all down), we spent some time discussing it and my PCP educated me about them and she made notes in the Education section (this month I've prepared questions for my surgeon consult which is coming up). I attached my list to that month's visit. I fill out my self-assesment of how I did on last month's goals, the Dr. fills out the rest. Hopefully this will do it! Good luck!

DIET & EXERCISE PLAN FOR PATIENT: ________________________________DOB______________

Visit #: __________ Date: ______________

Current Weight lbs.: __________

- GOALS ACHIEVED FROM _____/_____/_____ :

- Patient Self Assessment:

• Nutrition: __________________________________
  

• Exercise: ___________________________________
  

• Sleep: _____________________________________
  

• Accountability: ______________________________
  

- GOALS FOR NEXT MONTH:

• Nutrition:
  
  • Pt. to Follow ____________ Calorie Diet
    
  • Fluid: No Caffeine, No Carbonation, No Calories, Between meals only
    
  • Quality: Emphasize Protein, Low Sugar, Low Fat
    
  • Regularity: 3 meals per day, Eat every 4-5 Hours, No grazing, Slow meal down to 20-30 min.
    

  [*]Exercise:

  • Pt. to Exercise at least ______________ Min. per Week
    

  [*]sleep

  [*]

  • Pt. to Achieve 7-9 Hours per Night
    

  [*]Accountability:

  • Keep Food/Activity/Sleep Log (only as needed)
    
  • Support
    
  • Education
    
  • Stress Reduction
    

- COMMENTS ON PATIENT’S PROGRESS:

_____________________________________________

- OBESITY HEALTH EDUCATION/GOALS-Post surgery, behavior changes, history, comorbidities, etc.:___________________________________________

MD Signature

_______________________________________________

[Blue Bug 0]

I would ask both doctors at those 2 visits to document everything about your weight loss "plan" when you visit and mention that they placed you on a diet. That way you can use it for the 6-month supervised diet. I do medical transcription, so I'm thinking as long as they document your weight and specifically state that they put you on a diet in your chart, you can later submit those charts as evidence you have been on a supervised diet for this time frame. Good luck!