Dr. Supervised Diet?

[blondie2 0]

I've been reading some of these posts and they say that you actually need 7 months of Dr. supervised weight loss? What? I was told by my insurance BCBS of IL and by my patient advocate from Day One Health that I only needed 6. Some of these posts say you actually need 7? That the first month doesn't count??

[Godschild 0]

Thats what I am trying to figure out too. I have the same insurance and my dr. told me the first visit is day 0. Now I am learning mabey not. I will call my insurance tomorrow. This can be confusing.

[RestlessMonkey 7]

Just do what YOUR insurance says and you'll be fine.

That's the downside to this board, what is true for one person isn't necessarily true for another, and you need to do exactly what your surgeon and his support team tell you to do. Same with insurance; employers can modifiy it and it can vary from state to state depending on state law. This place can be a great source of support and information but you need to always check with YOUR team if you get contradictory info!

[Godschild 0]

Thanks...Im calling tomorrow

[RestlessMonkey 7]

Good luck! I hope it's only 6! :tongue2:

[lapbandgirl2009 0]

Hi Jennifer~

I am going thourgh 6mos insurance required diet and I agree with Restless Monkey that you should follow what insurance states. It varies case by case depending on insurance. But I know for me that in all my total visits with my registered Dietician that I am seeing would be 7 visits. The first appt is billed and coded usually as a intial consult and then after that one my "true 6month MSWL" visits started. I am on month 5 only one more month... YEAH I am so excited :tongue2: goes by fast. Good Luck

[blondie2 0]

I met with the nutritionist back in June and started my 6 month in Aug. So- Aug, Sept, Oct, Nov, Dec and my last one was Jan. So hopefully this counts

[GoneFishin 0]

Below is from BC/BS IL website. I finished my 6 mo. in Dec. 08 and psych evaluation and surgeon consultation tonorrow. I have a tentative surgery date of 3/03 with Dr. Hunter at Virginia Mason in Federal Way WA. subject to BC/BS IL approval. I am confident we have our ducks in a row and all will go smoothely. Hope this helps.

Blue Cross and Blue Shield of IL require the following, do you have every thing listed below

· At least a five-year history of Morbid Obesity supported by medical record documentation.

AND

· It is expected that appropriate non-surgical treatment should have been attempted prior to surgical treatment of obesity

Non-surgical treatment of morbid obesity appropriateness criteria:

· Medical record documentation of active participation in a clinically-supervised, non-surgical program of weight reduction for at least 6 months, occurring within the twenty-four (24) months prior to the proposed surgery and preferably unaffiliated with the bariatric surgery program. [NOTE: The initial BMI at the beginning of a weight reduction program will be the “qualifying” BMI used to meet the BMI criteria for the definition of morbid obesity used in this policy.]

· A program will be considered appropriate if it includes the following components:

1. Nutritional therapy, which may include medical nutrition therapy such as a very low calorie diet such as MediFast or Optifast OR a recognized commercial diet-based weight loss program such as WeighWatchers, Jenny Craig, etc.

2. Behavior modification or behavioral health interventions.

3. Counseling and instruction on exercise and increased physical activity.

4. Pharmacologic therapy (as appropriate).

5. Ongoing support for lifestyle changes to make and maintain appropriate choices that will reduce health risk factors and improve overall health.

Surgical Program for the treatment of morbid obesity documentation requirements:

· Documentation that growth is completed. [Generally, growth is considered completed by 18 years of age or with documentation of completed bone growth.]

· Evaluation by a licensed professional counselor, psychologist or psychiatrist, should be completed within the 12 months preceding the request for surgery. This evaluation should document:

1. The absence of significant psychopathology that would hinder the ability of an individual to understand the procedure and comply with medical/surgical recommendations.

2. Any psychological co-morbidities that are contributing to weight mismanagement or a diagnosed eating disorder.

3. Patient’s willingness to comply with preoperative and postoperative treatment plans.

[Godschild 0]

I called my insurance office and asked them if it was 6 or 7 visits. They told me..." all we require are 6 consecutive monthly visits. Your primary doctor will submit a predetermination letter that states you have completed a 6 month supervised diet along with his office notes and that all requirements have been completed." So I am hoping I can get my band in March vs. April

[RestlessMonkey 7]

I called my insurance office and asked them if it was 6 or 7 visits. They told me..." all we require are 6 consecutive monthly visits. Your primary doctor will submit a predetermination letter that states you have completed a 6 month supervised diet along with his office notes and that all requirements have been completed." So I am hoping I can get my band in March vs. April

See, there you go! This is a great Board but hope you've learned to always WAIT to panic until you confirm with your own doctor/insurance/team! :cursing: This procedure is NOT cookie cutter and each person's experiences are a little different; what is true for one person isn't necessarily true for the next!

Good luck to you!

[TQUAD64 9]

Well I cannot fight nor do I want to fight the system. I want my surgery! So when Blue Shield of California told me I needed 6-months of supervised diets, I said okay. I started January 2007 and thought I was done June 2007, but was told I actually needed to go to July 2007.

Really, what does one extra month really matter? So I did 7 months and I actually kept on going and continue to go to this very day. It cannot hurt you. You will learn from it. And it gets you one step closer to your surgery. So just do what you insurance company asks you to do. You will not regret it!

Best of luck to you and your journey.

[Bjornsyouruncle 0]

I had to do 6 months/180 days, which works out to 7 visits since the first visit is day 1. It is irritating to keep track of, so I just started counting Jan to Feb is one month, Feb to March is 2 months, March to April is 3 months, etc instead of counting Jan, Feb, March, etc since that would always be wrong.

But if you just need 6 appointments that would only be 5 months.

[Godschild 0]

Well either way I am just happy to be getting closer to having it done. I was just trying to figure out when my surgery would be becasue where I work, I am the only nurse and I have to get a temp to replace me. Sometimes it is hard to get a replacement. I appreciate all the help on here. This is a great place to get help and advice. You guys are great.