I know I will need to call my insurance company to clarify this, but I am curious what have experienced in this regard. 

My insurance requires 6 months of dieting before approving weight loss surgery.  It has to have taken place within the last 24 months.  Now I have been dieting off and on for... well, for many many years.  For the last 2 1/2 years I have used a program called "Diets to Go"  on and off.   It's a meal delivery service, for those unfamiliar.   I do have proof that I have been a member of Diets to Go for  2 1/2 years.  I wonder if this might be sufficient proof.  My PCP is very support and well aware of my many weight loss attempts, so I think she will support me in documentation on her end - however she has not been strictly monitoring these diets either.  (FYI, I have BC/BS of IL insurance, although I live in WI).

Did anyone have luck proving they had been dieting for the required time already, or do most people need to start from square one?   I know I will need to do a pre-op liquid diet for a period of time, so I am not referring to that requirement.  I am strictly talking about the pre-op diet required to get health insurance to believe that you made real efforts at weight loss in the past.

Thanks in advance for sharing any experiences with this here. 

I did Medi-Fast two different times and they must have accepted that since I was cleared in a few weeks.....Getting heart clearance was a whole other story.
I will say that a good surgeon's office will help you get approved with as few problems as possible.
My sister got approved with no problems with the same surgeon I had.

1) Most insurance companies have very specific guidelines - whi*****lude monthly visits to the doctor monitoring your diet, documented in your medical records.  They will want official copies of those dated medical records.  Your doctor should be smarter than to try to falsify or backdate records.  The insurance company can be assholically anal about this - because they can.

2) On the other hand, they could be kind and agree to accept the receipts and confirmation from your doctor that he was supervising you - but I wouldn't hold my breath.

3) In your position, I would start a supervised diet IMMEDIATELY, and at the same time, submit the receipts and a letter from your PCP saying you have been on a supervised diet for many months, although your PCP did not feel in his medical opinion, based on your physician-patient relationship that it was necessary to have you come in monthly.

4) And then after they refuse to comply, which they will, OR IN ADDITION TO YOUR INITIAL REQUEST FOR WAIVER (up to you), you could submit the following arguments:

The ASMBS has issued a position statement calling pre-op diet and weight loss requirements unwarranted, without basis in evidence-based studies and contrary to the standard of care in the US.  In fact, the vast majority of studies on the value of such requirements has clearly demonstrated that it is without merit and hurts patients.  Therefore, you request that the insurance company waive the requirement.  And if they deny the request for waiver, APPEAL through to external medical review, and/or appeal to the relevant Dept. of Insurance (don't know if that would be in WI or in IL - depends on the law in your state).

In CA, such an appeal would go to the Dept. of Managed Health Care via a grievance process, which would NOT require exhaustion of internal appeals, because it is a procedural (and not substantive) requirement (and not a question of medical necessity for or whether a medical procedure is experimental).  The CA DMHC has overturned every one of these ridiculous requirements when they have been requested to do so for several years - but they can't or won't make the insurance companies stop putting them in their policies and not telling their insureds that they don't have to do them.  You need to find out if there is a similar procedural grievance process in your appeals procedure, preferably one that DIRECTLY goes to the state Dept. of Insurance after the first refusal to waive the requirement (otherwise, it could take a couple of months, during which time you would still be building your compliance time in case it doesn't work).

Here is the citation to the ASMBS and the references:
ASMBS Position Statement: http://www.asmbs.org/Newsite07/resources/ASMBS%20Position%20 Statement%20on%20Preoperative%20Supervised%20Weight%20Loss%2 0Requirements.pdf

It is the position of the ASMBS that the requirement for documentation of prolonged preoperative diet efforts before health insurance carrier approval of bariatric surgery services is inappropriate, capricious, and counter-productive given the complete absence of a reasonable level of medical evidence to support this practice. Policies such as these that delay, impede or otherwise interfere with life-saving and cost-effective treatment, as have been proven to be true for bariatric surgery to treat morbid obesity, are unacceptable without supporting evidence. Individual surgeons and programs should be free to recommend preoperative weight loss based on the specific needs and cir****tances of the patient.

Look at the whole ASMBS document for more gems to quote.

Papers:
http://www.nature.com/oby/journal/v18/n2/full/oby2009230a.ht ml (full paper)
Obesity (Silver Spring). 2010 Feb;18(2):287-92. Epub 2009 Aug 6.

Effectiveness of a prebariatric surgery insurance-required weight loss regimen and relation to postsurgical weight loss.

Ochner CN, Puma LM, Raevuori A, Teixeira J, Geliebter A.

Source

New York Obesity Research Center, St Luke's Roosevelt Hospital, Columbia University College of Physicians and Surgeons, New York, New York, USA. [email protected]

Abstract

Most US insurance companies require patients to participate in a medically supervised weight loss regimen prior to bariatric surgery. However, the utility of this requirement has not been documented. Data was collected from 94 bariatric surgery patients who were required, and 59 patients who were not required, by their insurance company to participate in a presurgical weight loss regimen. Weight change in the required group, as well as group differences in weight change, was examined from 3 and 6 months presurgery to 1 week presurgery, and from 1 week presurgery to 3 months postsurgery. Weight change presurgery was then used to predict weight loss postsurgery. In the 6 months prior to surgery, required patients gained 3.7 kg +/- 5.9 (s.d.) (P < 0.0005), which did not differ from nonrequired patients. From surgery to 3 months postsurgery, required patients lost 23.6 +/- 8 kg (P < 0.0005), also without differing from nonrequired patients. Patients who gained more weight prior to surgery, lost more weight postsurgery (P = 0.001), while controlling for initial weight. Findings suggest that the common weight loss regimen requirements of US insurance carriers were ineffective in producing presurgical weight loss in this sample. Most patients (>70%) in this sample gained weight prior to surgery, potentially taking advantage of final opportunities to overindulge in preferred foods. Required patients fared no better in terms of weight change postsurgically and, surprisingly, presurgical weight gain predicted better postsurgical weight loss outcome. Several potential explanations for this finding are offered.

http://www.ncbi.nlm.nih.gov/pubmed/16925335
 

Surg Obes Relat Dis. 2006 Mar-Apr;2(2):122-7.

Insurance-mandated preoperative dietary counseling does not improve outcome and increases dropout rates in patients considering gastric bypass surgery for morbid obesity.

Jamal MK, DeMaria EJ, Johnson JM, Carmody BJ, Wolfe LG, Kellum JM, Meador JG.

Source

Department of Surgery, Division of Minimally Invasive Surgery, Virginia Commonwealth University Health System, Richmond, Virginia, USA. [email protected]

Abstract

BACKGROUND:

Preoperative dietary counseling (PDC) before bariatric surgery is mandated by a growing number of insurance payers. Their claim is that PDC improves outcomes and postoperative compliance. We compared outcomes of GBP patients undergoing a mandatory 13 weeks of PDC (n = 72) to a contemporaneous group of patients with no such requirement (no-PDC; n = 252) who underwent operation between January 2000 and December 2002.

METHODS:

The PDC and no-PDC groups were characterized by similar male:female ratios (1:4 vs 1:4.6), mean age (42 years), mean body weight (324 lb vs 309 lb), and mean body mass index (BMI) (52 kg/m2 vs 50 kg/m2). The PDC group had a higher incidence of obstructive sleep apnea compared with the no-PDC group (41% vs 28%; P < .04) but otherwise the two groups had similar incidences of obesity-related comorbidities. The presurgery dropout rate was 50% higher in the PDC group than in the no-PDC group (28% vs 19%; P < .05).

RESULTS:

At 1 year follow-up, the no-PDC patients had a statistically greater percentage excess weight loss (67% vs 60%; P < .0001), lower BMI (32 vs 35; P < .015), and lower body weight (197 vs 218; P < .01). Resolution of major comorbidities, complication rates, 30-day postoperative mortality, and postoperative compliance with follow-up were similar in the two groups.

CONCLUSIONS:

The data demonstrate that insurance-mandated PDC is an obstacle to patient access for surgical treatment of severe obesity and has no impact on weight loss outcome or postsurgical compliance. PDC should be abandoned by the insurance industry.

http://www.nature.com/oby/journal/v14/n3s/full/oby2006285a.h tml (full paper)
Obesity (Silver Spring). 2006 Mar;14 Suppl 2:70S-76S.

Previous weight loss experiences of bariatric surgery candidates: how much have patients dieted prior to surgery?

Gibbons LM, Sarwer DB, Crerand CE, Fabricatore AN, Kuehnel RH, Lipschutz PE, Raper SE, Williams NN, Wadden TA.

Source

Department of Psychiatry, Weight and Eating Disorders Program, University of Pennsylvania School of Medicine, 3535 Market Street, Suite 3029, Philadelphia, PA 19104, USA.

Abstract

OBJECTIVE:

To describe the dieting histories of bariatric surgery candidates.

RESEARCH METHODS AND PROCEDURES:

One hundred seventy-seven individuals with extreme obesity who sought bariatric surgery completed the Weight and Lifestyle Inventory, a self-report instrument that assesses several variables, including weight and dieting history. Patients' dieting histories were further explored with an aided recall during a preoperative behavioral/psychological evaluation performed by a mental health professional.

RESULTS:

Participants who completed the Weight and Lifestyle Inventory reported an average of 4.7 +/- 2.9 successful dieting attempts, defined as those that resulted in a loss of 10 lbs (4.5 kg) or more. These individuals reported a mean total lifetime weight loss of 61.1 +/- 41.3 kg. Despite these efforts, their weight increased from 89.4 +/- 27.4 kg at the time of their first diet (age 21.2 +/- 10.1 years) to 144.5 +/- 30.8 kg at the time they underwent their behavioral/psychological evaluation (age 43.0 +/- 11.0 years). Results of the aided recall revealed that participants had made numerous other efforts to lose weight that were unsuccessful. Self-directed diets and commercial programs were used more frequently.

DISCUSSION:

Individuals who sought bariatric surgery reported an extensive history of dieting, beginning in adolescence, that was not successful in halting progressive weight gain. Thus, the recommendation often made by insurance companies that patients delay surgery to attempt more conservative treatment options may be unwarranted, particularly in the presence of significant obesity-related comorbidities. Weight loss histories should be routinely examined during a behavioral evaluation to determine whether additional attempts at non-surgical weight loss are advisable. Future studies also are needed to explore the potential relationship between dieting history and postoperative outcome.


 

Wow! That is fantastic information and great advice!  Thank you!

  that's one for my WLS binder, thank you very much...   

I had done every diet out there! but very little actual documentation. My insurance accepted logs of my food and work out etc. ..and my  niece seriously just coppied my charts! She had never really dieted before, she made them up! and they accepted it.. I was a little annooyed cause I'm like "hey! I have actually REALLY been trying to lose weight for 20 years! And you just go copy  mine!" lol...so I would make up some logs or something maybe?

I'll cut you a smidge of slack, because your join date is today, and I'll assume you are actually new.

Are you seriously suggesting on a PUBLIC site, under what appears to be your own name and surgeon's name, that someone commit insurance fraud, as well as accusing your niece of having already commited insurance fraud?  Do you not realize that the insurance companies and surgeons have people monitoring these boards?

It's not too late.  I suggest you delete this post, deactivate and come back in a few days under a new account.  With a different screen name.

  yea, well with that avatar and the other poster responding I'm wondering too.. there are allot of freaking WEIRDOS showing up here suddenly.

Huh?  Whose avatar are you referring to?  Mine is of Twiggy, in case you didn't know.  I think she's adorable - just a fun pop culture reference to have her in the avatar.

Also, to be fair, it looks like you've only been here for about a month. ;)  So perhaps you are part of the influx of recent "weirdos".   (I'm just teasing, btw.)

And to be clear, I absolutely do NOT want to commit any kind of fraud. Yikes.  But I've been dieting for quite some time, and was hoping that I could use my member ship with Diet To Go as proof of that so I didn't have to spend more time and money doing a 6 month pre-op diet (the results of which I can already predict) when I could just be getting the surgery and on the path to regaining my health.

You should do your research and think before you assume I'm mentioning your "TwiggY avatar" before you talk to me that way because you just sound ignorant, and I certainly don't need to EXPLAIN MYSELF TO YOU or how long I have been around to YOU whoever the **** you IMAGINE you are.

Yes, I'm in a bad mood.


ok I just took a 2 1/2 hour nap. I feel kinda better. You do have a point there and if your "TwiggY" ( whoever that is) avatar had said that to my face I would of probably agreed, cuz now i see the facial expressions, but I'm not gay, so thanks anyway :)