Question about diet history requirements

[HolliJ 24]

I know many insurance providers require documented diet attempts and others do not.

The reason I'm asking is because I'm worried about qualifying. I'm waiting until after the seminar to question my insurance, though.

I have United Heathcare. Most of my previous weight loss attempts have been through calorie counting and exercise and not through a doctor. I've lost like 15-30 lbs at various points. I was also on a weight loss drug trial, through my endocrinologist, but I think that only lasted around 5 months (I dropped out, maybe it was 6 months). I've also tried Atkins. Not really anything else because I didn't have the money to spend on fancy things like Weight Watchers (went to like 3 meetings).

I also have no idea what the date ranges were that I lost weight.

What insurance provider do you have, what did they require, and what did you submit? How detailed do they expect you to be?

[crzytchr 3]

It depends on the coverage your employer has for the group. I had BCBS of LA and it covered my surgery. I had a qualifying BMI and with my surgeon, all I did was give past diets I had been on with approximate dates. I could have provided past weights with dr visits, but it wasn't requested. It depends on your coverage and you won't know until the insurance person at the surgeon's office calls and checks. My case handler was knowledgable enough that she basically told me what was required by me just giving her my insurance name. I was approved in days and had surgery within 3 weeks of my consultation. Good luck!

[Lisa07 0]

I attended a seminar today and learned that if your insurance requires a six month consecutive dietary program, it has to be by a physician, it can't be NutriSystem because you are doing it unsupervised. Some insurance doesn't even allow WW or Jenny Craig because you aren't being seen by an actual physician. My insurance wants six months but it can be 2 three month dietary programs, I have one but I need to make three appointments with my primary doctor and each month there is a list of things he needs to discuss and document in order for the insurance to accept it.

Record weight and vital signs

Discuss nutrition

Discuss excersie, the type you are doing and the amount of time you are doing it

Discuss current medications

Discuss changes in medications

Discuss changes in comobitity

Discuss additional conditions due to your weight (such as bad knees)

Discuss good eating habits.

If your doctor doesn't document all of this for each visit, the insurance could turn you down and you start all over!

I also learned there are alot of out of pocket expenses but I would rather pay those then for the entire surgery! Plus you are going to save money when you eat less after surgery!

I think the easiest insurance to get approved by is BCBS, one guy had that and she said he could probably have his surgery w/in the next month or two...lucky duck!:grouphug:

Hope this helps, good luck on your journey,

Lisa

[crzytchr 3]

Lisa, yeah your coverage sounds typical. Most companies do require all of that. It is the company and your employer that decide all of the requirements. I have no clue why it was so easy with mine, but my friend and I both worked for the same company and we were both APPROVED in days. Good luck!

All of the preop requirements will actually help you once you start your banded life, so it is all good. Make sure you ask how much you are required to lose during the supervised diet. Also, if your bmi is low, are you going to be penalized and turned down if you fall too low?

[BamaBlondie 0]

I have BCBS and they require the six months follow-up with a Primary Care Physician prior to surgery. SO... I called the dr that I plan to have the surgery with and I'm using a PCM physician that they recommended. That way I know that I'm using someone who is familiar with my doctor and what notations to make. One thing to note, most BCBS plans WILL NOT pay for the PCM visits. My PCM's first visit to 'establish' me as a patient for potential weight loss surgery is $150. Then each follow-up visit is $30.