If your insurance requires you to do a 6 mo. program of medically supervised weight loss, how did you do it?  Does your insurance cover non-surgical weight loss programs?  If not, did you have to pay out of pocket for whatever program you did?  I'm thinking of using my PCP, but I'm sure that he'll code it weight loss and it won't be covered, thus I will be paying out of pocket.   

Just wanted to throw out some information on some new healthcare refore rules... I know its tough to navigate the insurance web these days so wanted to share!!  :)




http://www.coverageforall.org/pdf/individualhealthreform.pdf

This is an issue that happens over and over.  Even with detailed notes the insurance provider may deny it, but then it can be appealed and backed up with their own insurance criteria.  Just be sure to do exactly what they say. 

Your primary MD can document the supervision in their notes.  I was in an optifast program but that data didnt matter as much as my MD notes.  When you see the MD two times a month bring in your logs and have them copy them and attach them to your chart signed by the dr too.  You keep a signed copy as well. 

Sagamore is actually Cigna I think.  Online it should list the criteria in detail for the surgery approval.  When I did my own appeal I found that info and took it line by line and followed the criteria.  It worked in the end. 

PM me if you have any questions id love to help :)  Take care!!

Your primary care would probably be ok, they just have to note specific things, which maybe others here have more details on.  Weight, height, review of food logs, behavioral issues, exercise, blood pressure, pulse, review of any medical conditions, recommendations for modifications/adjustments, these are all things that should be charted, but there may be more specifics....

Best of luck...  I am dealing with this part of the process as well...

 My insurance (Sagamore) requires 6 month of a medically supervised weight loss program.  I must be weighed and seen 2x/month, keep food & exercise logs, and the notes from the doctor must be detailed about what I'm doing and what they recommend.  Here's where I'm hitting a wall - who do I find to supervise my weight loss program that will know exactly what kinds of records the insurance will require? I spoke with the hospital where I'm having the surgery's non-surgical weight loss center and they are an option but  it would cost me $260/month minimum because my insurance said that they don't cover ANYTHING other than the surgical weight loss.   However, the weight loss center told me that they are covered in 90% of cases because it's required for insurance.  They can't tell me until they file my first visit if mine would be covered.  I can't afford to pay $180 our of pocket for my first visit just to find out that none of it will be covered.  That would be $1200+ for the 6 month period.  Yet I'm afraid that my family doctor won't get all of the detailed notes that are required.  Who did you get to do your supervised medical weight loss?