Playing a game I hate (insurance)

Apparently my program seemed to work, but the requirements of the 90-day "multi-disciplinary surgical preparatory regimen" are pretty detailed and strict.  If you don't want to or can't be that strict, then they require a 180-day doctor-supervised diet, per Clinical Policy Bulletin 0157.

***
Member must meet either criterion 1 (physician-supervised nutrition and exercise program) or criterion 2 (multi-disciplinary surgical preparatory regimen):

1. Physician-supervised nutrition and exercise program: Member has participated in physician-supervised nutrition and exercise program (including dietician consultation, low calorie diet, increased physical activity, and behavioral modification), documented in the medical record at each visit.  This physician-supervised nutrition and exercise program must meet all of the following criteria:

   1. Member's participation in a physician-supervised nutrition and exercise program must be documented in the medical record by an attending physician who supervised the member's participation.  The nutrition and exercise program may be administered as part of the surgical preparative regimen, and participation in the nutrition and exercise program may be supervised by the surgeon who will perform the surgery or by some other physician.  Note: A physician's summary letter is not sufficient documentation.  Documentation should include medical records of physician's contemporaneous assessment of patient's progress throughout the course of the nutrition and exercise program.  For members who participate in a physician-administered nutrition and exercise program (e.g., MediFast, OptiFast), program records documenting the member's participation and progress may substitute for physician medical records; and
   2. Nutrition and exercise program must be supervised and monitored by a physician working in cooperation with dieticians and/or nutritionists, with a substantial face-to-face component (must not be entirely remote); and
   3. Nutrition and exercise program(s) must be for a cumulative total of 6 months (180 days) or longer in duration and occur within 2 years prior to surgery, with participation in one program of at least 3 consecutive months.  (Precertification may be made prior to completion of nutrition and exercise program as long as a cumulative of 6 months participation in nutrition and exercise program(s) will be completed prior to the date of surgery.)

   or

2. Multi-disciplinary surgical preparatory regimen: Proximate to the time of surgery (within 6 months prior to surgery), member must participate in organized multi-disciplinary surgical preparatory regimen of at least 3 months (90 days) duration meeting all of the following criteria, in order to improve surgical outcomes, reduce the potential for surgical complications, and establish the member's ability to comply with post-operative medical care and dietary restrictions:

   1. Behavior modification program supervised by qualified professional; and
   2. Consultation with a dietician or nutritionist; and
   3. Documentation in the medical record of the member's participation in the multi-disciplinary surgical preparatory regimen at each visit.  (A physician's summary letter, without evidence of contemporaneous oversight, is not sufficient documentation.  Documentation should include medical records of the physician's initial assessment of the member, and the physician's assessment of the member's progress at the completion of the multi-disciplinary surgical preparatory regimen.); and
   4. Exercise regimen (unless contraindicated) to improve pulmonary reserve prior to surgery, supervised by exercise therapist or other qualified professional; and
   5. Program must have a substantial face-to-face component (must not be entirely delivered remotely); and
   6. Reduced-calorie diet program supervised by dietician or nutritionist

and ***

AAAAAAAhahahahahahahahahahaha!

Thank you to you all for telling me to check with my insurance company.  They told me that it was approved and they just notified my doctor's office this morning (I just haven't heard yet).  WOOOHOOO!  No more games!!!!

 congrats!!!!

 YAY!!!!!

I understand becuase I was right here as well.  My insurance required that I be 100 pounds overweight, which I barely was at the time I began my quest for surgery.

When my surgeon expressed his fears that I might not be heavy enough, I simply assured him that me gaining any additional necessary weight would not be a problem...

Yes, it sucks to have to play the game, but I was going to do whatever I needed to do to get this surgery. 

Hang in there as you're almost there!!!