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
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
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).
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.
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).
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.
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.
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.