Insurance & 12 month diet requirement

My doctor is referring to me to Dr. English in Marquette for WLS.  My insurance company requires a "physician-supervised weight loss program for a minimum of 12 consecutive months within four years prior to the recommendation for bariatric surgery."   Does anyone know if attempts at Weigh****chers would count towards that?  I know I saw at least one person on this board that is currently going through with that 12 month requirement... I guess I am wondering if I need to if I can go to WW and just have my doctor weigh me periodically or does a doctor have to put me  on a diet?

My Dr had me doing WW for my presurgery diet and he had to see me once a month per insurance.  I could not miss a month or I would have to start over.  You need to make sure your Dr codes your office visit for weight loss.   I was able to get away with fewer months of supervised at that time because my Dr had charted our weight loss talks and efforts for the previous 18 months and they counted them.  Good Luck!

I am going through the 12 month diet right now.  I'm not using Weigh****chers, but it is a program that was recommended by my surgeon --- he actually send a referral form to the program as part of it being medically supervised.  I check in monthly for weight in, nutrition discussion, report on my exercise efforts, get my blood pressure/pulse taken.   You'll want to double check with your insurance company to find out if WW is acceptable for their requirements.  Every insurance is different.  For instance, my insurance doesn't require that I see my doctor (or do a weight in) every single month for 12 consecutive months.... but if I visit my doctor quaterly, I'm fine.  And yes, I have that in writing from my insurance company.   You'll also want to check if your insurance covers "treatment for obesity" ..... mine doesn't.  So the previous posters advice to have the office visit coded as weight loss could actually mean you'll have to pay for that office visit out of your own pocket because your insurance company won't pay for anything related to obesity treatment.  It's a pretty common exclusion clause from what I've heard. As for the question of if your doctor has to put you on a diet.   If he recommend WW, then he IS putting you on a diet.  But if insurance doesn't recognize WW, you'll have to discuss with your doctor a plan that will satisfy insurance.   You'll also want to get the exact wording from your insurance company about what is included in that diet requirement.  For me, it's more than just "diet".  The language basically states there must be changes in lifestyle habits, exercise, nutrition and even discussion about prescription aids if necessary. Good luck Pam

Roseybud5- For my insurance, all I did was register at sparkpeople.com and followed the diet plan that they recommended for me.  Then once a month, I printed out the reports and went to see my pcp.  He weighed me in and we discussed what I had been doing.  AND IT WORKED FOR MY INSURANCE REQUIREMENTS.  I had surgery 6/4/07...

Just to clarify, which I should have done in previous post.   My insurance does pay for weight loss office calls if you are actively looking into WLS which they pay for if you qualify.  They will pay for all of the pre-testing and qualifications and then they decide if they will pay for the surgery or recommend you stay on current weight loss plan. They also said I had to lose 10% of current weight or show progressive weight loss and be close to 10%. Yes you need to make sure your insurance will pay for the weight loss visits...but even if they don't if they require the visits and you have it coded as something else it won't count.   Catch 22 but there it is.

Thank you for all the quick responses... the letter I got from BCBS said "documentation should include periodic weights, dietary therapy and physical excercise, as well as behavioral therapy, counseling and pharmacotherapy as indicated."    Dr. English's office sent me a listing of insurance critera for when I call the insurance company whi*****ludes the diagnosis codes and procedure codes.  Looks like I will have to sit down and give BCBS another call, since I did not know all of this the first time I called them. Now I can see why so many of you folks call this a "journey".  I am a stress eater... by the time I get through all this I will be another 20 pounds heavier! YIKES!

Yep, it's definitely a "journey" .... more like a circus with all the hoops we need to jump through.  LOL! Knowing you're a "stress eater" is a good thing.  Now that you KNOW that you can work to reverse those habits now, before your surgery.  Might as well take advantage of these next 12 months and figure out your mental eating issues so when you've got your new pouch that's been dealt with already. The statement you got from BCBS is the same thing I got too.  So it looks like it's standard for BCBS in the area at least. Pam

It didn't count for me.  I actually had to go in and see my doctor for 12 months straight and don't miss an appointment.  They are watching to see if you stick with it. Best of Luck to you!!