6 mo. MD supervised weight loss attempt

Joe · October 11, 2005

I have to submit a 6 mo. MD supervised weight loss attempt w/ weight-ins letter to my doctor for the insurance company. I will hopefully get this letter on Wednesday when I go see my PCP.

Does any one have to do the same thing? And if so do you have a sample letter. I would like my PCP to get this done ASAP.....

Thinjen · October 11, 2005

Since I started this process, I have been seeing my doc for various things on a monthly basis (just had visit number 3). The nurse at the band seminar advised this because she said that the ins might pull this stunt. Coincidentally, I've really needed to see the doc...had lots of sinus infection problems. Anyway, I always make sure that we discuss my weight and what I'm doing about it. I'm also keeping a food journal. Sure enough, my ins wants to see 6 months of dieting with my doc's supervision. So, I'm looking to have it done after Jan. Bummer. She hasn't written a letter since their denial. We're waiting for my 6 months to be completed. To date, I've lost some...gained some. Just like normal.

beccamay · October 11, 2005

I am in the same boat, my insurance was saying as long as you have a BMI of 35 there will be no problems then i get a call from the doctor's office saying I need a 6 month doc supervised diet and exercise program. I have now seen the doctor to start the program but began to think about the times i have been to the doctor in the past year and i know my weight has been brought up so i have now started pulling records from my Dr. Office and OB/GYN. So maybe I can go to the doctors office for just a couple months instead of the 6 they are requiring. I am just wondering if there are going to be any more hurtles to jump after this? Hopefully I won't have to wait until April. I've been dieting since i was 16.

Time to love me · October 17, 2005

~ This is a copy of my post on another thread, I just added some other info.~

If you had recent blood work, EKG or any other test that's required, you might be able to get a copy of those results and use those, instead of taking them again. It has to be within six months (some surgeons allow a year). Also, I did not have to have a sleep test or stress test. For me, I didn't have any medical reasons to have this done. But your Dr. may still have you do it. All Dr.'s are different, and as you will find, insurance companies are very different from one another.

Get your weight history together. I got advice from a lady whom was already banded, so what I did was gather history from youth to adulthood. I then put what diet or exercise program I used, start weight, how long I was on the diet & how long it took me to gain the weight back.

Example: Age 20 Weight Watchers: 7-8 months, start weight 180, lost 20 pounds and gained 30 back within 6 months.

If you have an Ob/Gyn or any other doctor, that you see on a regular basis, you should get medical records from them too. It may have helpful info. like your weight history. Also, I went to WW, curves and any other program I used and got all my history from them. I then handed all this info. into my surgeons office and they submitted it to the insurance company, along with a letter from my PCP (primary care doctor). One last thing (my PCP had me do this).. just in case the insurance company denies you and wants you to go on a supervised weight mangagement plan, make an appt. every month with your PCP and make sure you have them note it as a weight related appt. and when you go, just do a weigh in and tell the dr. that you have been eating a healthy diet to try to lose some weight (have him/her give you a list of healthy foods to eat while dieting,he'll have to note this in your file). This will give you a head start and also count for a supervised diet with many insurance companies. * I know some are asking for a copy of a letter their Dr. sends, this is hard... I know, in my case, I didn't see the letter he sent. From what I gathered from some friends on LBT, most of them didn't see their letter either. Although, I am sure that some people have seen their letter. *

I have to say that I do not have my date set for surgery yet, but I have been in contact with my insurance company and I spoke with the person handeling my case to make sure all my info. was accurate. She complimented me on how organized I was with the info. and told me it was very detailed, that I most likely will have no issues with being approved. I gave them everything they needed and then some so that they won't have much to kick back and say I need this and that and this and that. On top of that.. at my surgeons office they do meetings in groups of 4 and out of the 4 I am the first to go because I have everything all done. One of the other ladies is now waiting until Jan. just to see the Dr. I went in Sept. and I have an appt. on Nov. 2nd. So go prepared with you test results, if you have any and all the info. you can get. It may save you a step down the line. Best of luck to you!

ladysplenda · October 17, 2005

I had to see a nutrtionist for six months and she reproted to my doctor.This is what BCBS required.

sarcar · October 18, 2005

I had to have one year documented unsuccessful weight loss that was doctor's supervised; Stress Echo; Pulminary Test; another diet that would be the diet I would be after the surgery- three months supervised by nutritionist and md; full psych evaluation from psychologist not associated with the surgeon. They will make you jump through hoops, so prepare yourself mentally. They are trying to weed out those that are not willing to keep going. DON'T GIVE UP. Just keep doing what they say and you will get through it. It may be difficult at times - but I've finally gotten approval and I started in April.....Carolyn

Time to love me · October 18, 2005

I also have BCBS, but I didn't have to do some of the things that others have done. I have to say that I am very lucky. There are 2 other girls on LBT that have the same type of BCBS and we didn't have to have the supervised diets, we also did not have to see a nutritionist. I guess it just depends on your state and then, what level of insurance you have with that company. It's best to call the insurance company and ask for the website you can go to so you can review the coverage for weight loss surgery, if they even cover it, and what is required to get the surgery.I still gathered my history and send it along, just in case the insurance company had a question on my dedication to losing weight.

Joe · November 6, 2005

HI evryone

Well I just found out the other day, If effective Jan 01, 2006 The co-pay for the surgery will be 5,000.00. Right now it is 250.00...I still need the 6 month weight loss attempt documentation. My case worker seems to want to help and replyed to my e-mail when asked if the Atkins diet was ok to list..the reponse was:

Hello again, any diet followed, along with regular vs and documentation of your results by whoever is following you on this should suffice. And yes…..they would be looking for 6 consecutive months of documentation on wt. loss efforts…….

So Hopefully I can get the doc to fill out paperwork on mondau so I can fax them

Any comments ????

beccamay · November 7, 2005

I seem to be having a simular problem, I have gone to the doctor to start the guided diet and started pulling my records from the doctor's office and I have documentation of starting the diet in May 05 and again documented in September 05 and now again in November 05. I am not sure though if it has to be documented month by month, in September my doc said to come back in two months. And i can't seem to get a straight answer from my insurance.

November 11, 2005

The more amunition you have to fight the insurance companies with the better. I'd go to the doc month by month and as The fourht posting under here said you can't have to much info when it comes to them. She had lots of good examples of what to do. I have to have 18 months of suprevised weight loss visits and just found out that they may not count the time I was taking Meridia and Adapex even though I went to see the doctor about it every months for eight months. The insurance companies are going to do whatever they can so you need to have your ducks in a row. I'm so glad for those of you whom this process is easy, but for a lot of people it's really hard and as SARCAR said in message 6 they are trying to weed us out. Pull your doctor records, say what you did every year weight watchers, curves etc. Even if you weren't suprivised it still shows a pattern and many of the doctors believe that those of us who traditionally go up and down, but show we can lose on the diet are the most successful with the band-of course this is just what I've been told by my docs. All I can say is you got to be as prepared as possible, don'e give any excuse for them to say no. If you were taking diet pills in highschool write it down. If your mother started you on a diet the day you turned 13 wirte it down. Just try to not lose hope.

Kadtie.