First post, Questions about 6 month supervised diet

Brittany H.
on 3/23/14 11:09 am
Long time lurker on here and now finally on track for surgery! Had my first consult on February 27th with Dr Kolasch at Southeast bariatrics in Charlotte. I found out my insurance (Empire BCBC) DOES require the six month supervised diet. Initially this was extremely frustrating for me as i know it has been for others. I have only been in Charlotte for the last 7 months so my new PCP I don't have much history with, but she understands and knows about my pursuit of WLS. Whats confusing about it is that i am seeing a PCP for the monthly check ins ( they call it med management?) and am SO WORRIED that I'm not going to follow the requirements or miss something and get denied in 5 months when my bariatric office submits my paperwork to insurance Anyone else have to do a 6 month supervised diet and if so what exactly did you discuss or have recorded by your PCP at each appointment??? this last month that i went in they weighed me, took my BP, Doc came in for maybe 4 minutes, palpated my abdomen, listened to my heart, told me i had lost 3 pounds-good for me because my BP also came down and sent me on my way. As i left the room i was sure to ask "you'll record everything at my visits for my insurance right?" and she says yes of course. I'm afraid that I'm going to miss something or not have enough information. My insurance is already super vague about what exactly should be included in a 6 month supervised diet.  Every time i have called, they just refer me to documentation online. Any suggestions or personal experience with the 6 month supervised visits welcomed!  So far what i have completed on my WLS journey:
  • Exercise Evaluation: Check
  • Nutritional Evaluation: Check
  • Psyche Eval: Scheduled
  • Support meetings:Scheduled
  • EGD: Scheduled
  • Sleep Study: Scheduled
  • 6 Month Supervised diet: on-going 1 month down, 5 to go.

5'3" HW:295  CW:283  GW:145

 

    

dalaimama
on 3/23/14 11:22 am

I guess my thinking is that the doctor and clinic I'm using is pretty familiar with what my insurance requires (actually the first visit/consult was with the insurance coordinator who had checked my coverage and explained everything to me and gave me copies of everything). I figure they want it to get approved just like I do so they're motivated to do it right too :)

I have Aetna, and I think I understand the requirements to be that I do a three month multidisciplinary program in which I have to have three documented visits to the office which ends up being a total of four months and I can't actually gain weight during that time. I feel okay about it because a friend has the same insurance and went to the same clinic and everything went smoothly..maybe I shouldn't be so naive lol I work with insurance companies a lot and I know how they are :P

~Cheryl

    
Sparklekitty, Science-Loving Derby Hag
on 3/23/14 2:16 pm
RNY on 08/05/19

I have BCBS Arizona and had a 2-month supervised diet, which I did with my PCP. All they needed was a note of a doctor's visit in consecutive months with a record of my weight, and a note saying that we discussed my food and exercise-- that was it. I guess the nurse copied down my chart notes from each visit and those were faxed to insurance and worked just fine.

If you're not getting details from your insurance company, I'd suggest seeing if you can talk to the insurance coordinator at the surgeon's office. Mine was super helpful and she'd worked with my insurance company many times, so she knew exactly what was needed to make sure I would be approved.

Sounds like you're getting all your ducks in a row, way to go! :-D

Nerdy Little Secret (#42) - Derby Strong!
VSG 2013, lost 150lb - RNY conversion 2019 due to GERD


basilmk
on 3/23/14 2:31 pm - FL
RNY on 01/07/14

Check with your surgeon...mine had a form that my PCP was required to complete at each of the visits.

Jillify
on 3/23/14 7:33 pm - Glendale, AZ
DS on 04/01/14

I was having a really hard time losing weight on my own, so I went to Jenny Craig and visited my PCP monthly. (JC works great for me while I'm on it... afterwards not so much). At the visits, my doctor encouraged me to exercise a little more each month and basically said we could make the visit as long or as short as I needed. My PCP had lots of experience documenting for WLS, but if your PCP is less comfortable, your surgeon should have a form for each visit he/she can use.

I was very sure at each weigth visit to say, "I think this is my Xth visit toward my 6 months of supervised diet. Can you verify that that will be recorded in my records?" I made sure I lost every month (although over Christmas I only lost 1lb). 

Brad Special
Snowflake

on 3/23/14 10:28 pm
VSG on 12/06/12 with

MY PCP really had no part in mine. He was on board but I did everything through my surgeon. I went to a 3 hour nutrition seminar to start then once a month went to my surgeons office. I had four visits with a nut that worked there and saw everyone else along the way and got everything else done. I did have to get my surgeon to fill out a weight loss history and sign off on giving me support. My last nut meeting was the same day I met with the surgeon for the first time. He said we will put you in for approval lets get you scheduled and I had it done a few months later.

AK_Gipson
on 3/23/14 10:53 pm
VSG on 04/14/14

I had to have proof from previous doctor visits, that listed my weight, for 2013,2012, 2011, 2010. This was a requirement from my insurance company. If you just moved, this may take awhile for you to get. See if it is on your "to-do" list. I had to get several doctors to submit, because I didn't have bad health, just overweight. So it wa**** or miss if I went to my PCP that year,(usually only if I had strep).

           HW:292 / SW:258 / CW 173.9

      
  

MarcyisMyName
on 3/23/14 11:22 pm
with

I am in NC as well, My surgeon's office also gave me a form to have filled out each week. My PCP was none too happy with the amount of paperwork he had to complete, but hey, I am paying him to do just that. My form has my starting weight, weight loss, current calories & exercise program and suggested calorie counts and exercise program for the new month. Its literally just to be sure that insurance has proof that I was guided by my doctor for six months.

LessHumid
on 3/23/14 11:43 pm - Baltimore, MD
RNY on 09/18/14

I can only speak to my experience... I have United Healthcare and the 6 month deal is required(I'm on month 3).  The supervised nutrition is included by the University of Maryland Center for Weight Management.  At the meetings(they're group sessions) we discuss food choices, how to deal with cravings, what we'll be able to eat, vitamins/supplements we'll have to take before and after surgery, and recipes to make unhealthy foods less so.  We're weighed and have to submit food diaries and activity logs for four days out of the month. I don't know if you'll be required to do those but I would just in case; better to have them and not need them than the other way around.

56sunShine14
on 3/24/14 1:14 am

I just took out a BCBS policy specifically for revision and VSG surgery and specifically asked them if a waiting/diet period was needed and was told no.  Isn't that considered a Pre-existing condition and now illegal?  I am really wanting to know about this.

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