Question:
Has anyone been able to get around the 6 month required Dr diet for pre-auth?
I am seeing my PCP on Monday. I understand from the surgery program coordinator, that I have to have 6 visit hx of monthly documentation of BMI and weight, and diet progress, before I can get insurance qualification. My MD followed me monthly 4 yrs ago, but not recently. The past year, I've been in counseling and I bought an eliptical so I don't have gym records. I was in personal training 4 days a week for 1 1/2 years, but that was 2 1/2 years ago... I'm trying to get those records. I called my insurance and they said the MD has to confirm 6-12 months of medically followed diet. I wanted to get my surgery before the end of the year so that my insurance deductibles won't go up as I understand they will in Jan. Any ideas...anyone? Thanks... — Prov31 (posted on September 11, 2009)
September 11, 2009
I had just used old records from weight watchers and jenny craig to show my
supervised diet, I also noted that every single form of attempted weight
loss products. I don't think you will be able to get around that
requirement. All insurance companies have that. I think it is just to
show that you have attempted to lose weight in the past and didn't succeed.
I think my weight loss records where from 97-04. You might not need to do
a current weight loss program if you can get your records. Hope this
helps. There are several reasons why the insurance companies require the
supervised diet. I didn't have proof of a "medically supervised"
one, but my doctor did write in my letter of medically necessity" info
that I had been trying to loss weight for years and couldn't do it. Also,
he put in my record that I had PCOS, (poly cystic ovary syndrome) and with
that condition women don't loss weight easily and become insulin resistant,
which in turn goes back to all the attempts at trying to loss weight
without keeping the weight off or even able to loss weight. I was on
weight watchers for one year and only lost 27 lbs. I worked out 3 days a
week and didn't cheat on the program. I was planning a cruise so I had
motivation. Hope this gives you an insight on things.
— Kristy
September 11, 2009
I could not get around this,I had to have 6 months,in this year, diet with
pcp, then I had psychologist exam,then a seminar, before I could even get
approval.Each insurance company is differant,just call your insurance,they
will tell you your requirments!Hope this helps.
— rebecca W.
September 11, 2009
I honestly didn't have to wait 6 months.. I started this in June and am
having surgery on the 23rd. I will share with you that I used Optifast to
lose 15 pounds and it worked within a month! Another thing I did was write
EVERYTHING down! I did not exercise (Hate it!!) and just drank a lot of
water.
Good luck!!!
— LinnieJean
September 12, 2009
it just depends on your insurance. I didn't have to do the supervised
weight loss. I had my initial appt with the doctor 10/7/08 and had surgery
12/8/08. If your insurance requires the 6 month supervised diet you will
have to follow their rules. Maybe you will get lucky and they will accept
your past attempts. I know you don't want to wait, but if you have to, take
that time to learn your new eating habits. It willl be worth it if you do.
Good luck and keep us posted.
— Dawn A.
September 12, 2009
Go to the library and pick up 5 or 6 diet books, copy the covers and the
outline of the diet. Send it to the insurance and tell them you tried all
these diets. I did and I never did go on any of them.
— Kimberly Ten Kate
September 12, 2009
If your insurance has spelled it out in their Medical Policy as a
qualification for weight loss surgery then there is no way around it.
However, if there is no time period limitation (mine said within 2 yrs),
then you may be able to submit the records from the program you were on 4
yrs ago with your doc. It needs to show a weigh in every month and file
notes of what was discussed about weight loss (i.e., prescribed lower
calories, etc.). Also be sure to include proof of the personal trainer and
counseling as all three of these components are usually what most insur
companies require. You didn't say what insur plan you have but if it
happens to be a Blue Cross Blue Shield plan you may want to double check as
they recently modified their requirement of a 6-mo. diet to only 3-month.
Even if you do have to do the 6 months chances are you will learn even more
because you will be going into it with surgery as a new tool. As you've
probably read here, this is not the easy way out of obesity. If anything,
food and eating becomes more of a focus after surgery because you have to
re-learn how to eat and eat right to both lose and maintain your health.
Best of luck to you on your journey!
— Arkin10
September 17, 2009
You need to do the diet. It will help you maintain your weight after the
surgery. If you wont do this now you will have big trouble later.
— trible
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