Question:
Is there any way of getting around the 12 mo doctor supervised diet?
— KathyE (posted on April 7, 2006)
April 7, 2006
Hi Kathy - I am not sure about your specific insurance but I have Aetna HMO
and they required a 6 month doctor supervised diet. My PCP tried to help by
writing the insurance company a letter stating that he has recommended
different diets and that they all failed. This was not accepted, so I am
thinking if they require it there is no way around it.
BTW: I ended up self-paying and going to Mexico.
Kim
— kimmy
April 7, 2006
I would suggest you familarize yourself with your Health Plan's policy on
WLS. It can be found at:
http://medicalpolicy.hcsc.net/medpolicies/home?corpEntCd=IL1&path=templatedata\medpolicies\surg\data\SUR716.003_2005-01-18&ctype=MEDPOLICIES-POLICY&cat=SURGERY#hlink
There are 6 specific criteria you must meet prior to being approved. When
a policy is as specific as this one, it is hard to get around any one item.
Best wishes and good luck on your journey.
— nursenut
April 7, 2006
THAT IS REALLY A QUESTION YOU SHOULD BE DISCUSSING WITH YOUR INSURANCE
COMPANY, 12 MONTHS IS QUITE LONG AS MOST COMPANIES I HEARD OF ONLY HAVE A
6 MONTH DIET. MAKE SURE THERE WAS NOT A MISTAKE
— Steve Cohen
April 7, 2006
This time Steve really does not know what he is talking about. There are a
number of insurance companies that are requiring a 12 month supervised diet
try. BCBS is one of them. Some polices are requiring between 3-12 months.
The one thing that he is correct on is that you really need to touch base
with your insurance. Some of them are very firm on this requirement whether
it be 3, 6 or 12 months.
— ChristineB
April 7, 2006
Well folks, I have to tell you, I have you all beat! My insurance company,
M-Plan, requires an 18 MONTH physician supervised diet plan and there is NO
way around it! When I first discovered this, I was extremely frustrated
and talked to everyone I could about it, but they just will not relent.
So, I am in month three of my eighteen months. It's really just a way of
the insurance company putting off paying for something that they are hoping
you will lose interest in. I think that is playing dirty, but I am not in
charge, ha. Now I tell everyone I talk to to make sure you find out about
your insurance plan's requirements RIGHT AWAY! Even if you are still
unsure as to whether this too is right for you, at least you will know what
you need to have finished. Martina
— Martina B.
April 7, 2006
I tried to get around it because I had gestational diabetes and thought
that the diet my ob/gyn doctor put me on would count...it didn't (BCBS). I
agree that it is a game with most insurance carriers to see if you are
going to follow through. I am so glad that I made the decision 12 months
ago to go through with this....so now I am not asking myself, "What
if?"
— Jenigal1974
April 9, 2006
One user stated that BCBS requires 12 months. I think it depends on the
policy, state, etc. because we have BC and there was no such requirement,
only that we meet the physician's guidelines (which was 3 months minimum)
and BMI limit. If you just call your insurance, you might receive a
different answer each time. Ask for a copy of the policy language in
writing. Have your surgeon's group submit the paperwork as they are often
more experienced in getting these things approved. Good luck
— rlhester
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