Finding Dr. For Medically Supervised Diet

Hello

My name is Peter and I am new to the forum. My insurer (Aetna) requires six months medically supervised diet. I am resigned to it, but they have put me in a big catch 22. There is no doctor even remotely close to me who is willing to do this and also takes insurance. Neither the bariatric surgeon nor my primary care physician will do this. I am on a fixed income and cannot afford to go out of network for this. And I live in Chicago! Where there are lots of doctors. Aetna does not know of anyone in network who can do this either.

I am at wits end since I cannot start the clock on this to eventually schedule my surgery. Can anyone help?

Much appreciated

Peter

Hi Peter, I am from the Chicago suburbs and I see Dr. Rantis out of Suburban Surgical care group. their bariatric program is phenomenal and they were very organized and gave me everything I needed in writing right after I had my first consultation. I am not sure whether you're nearby but they are out of Hoffman Estates.
I would hope that the bariatric program you are going with has some sort of guidelines they want you to follow and will work with your specific insurance so you can get what you need to be approved for the surgery...if not, maybe you should look for another doctor or program?

I also work with insurance for a living, and I would advise you to find out from your insurance exactly what they need as far as "medically supervised diet"...my insurer only required me to have 6 visits with any physician or dietician that documented my weight at my visit, and that we discussed my progress...it was not super strict.
I just had to have my PCP fill out a form that the insurance sent me, it was one page and he had to write down my weight, a sentence about what I was doing to attempt to lose weight, and the date on 6 separate visits within the past 5 years. that was it.

It also may be a requirement of your bariatric program, in which case they should be able to recommend a dietician to you...if the bariatric surgeons office does not have a list of providers they can refer you to, I would probably recommend calling your insurance and finding out whether a dietician or nutritionist is covered and where you can go to see one.
the insurance plan will definitely be able to provide you a list of in-network providers. that should probably be your first call.

good luck to you!

I'm going to second the suggestion to figure out exactly what insurance means by "medically supervised diet". I also got away with 4 visits (3 month program) to my primary with nothing more than him writing a letter each visit saying "patient weighted so many pounds and is doing blah blah blah to lose weight" and there was no problem getting that accepted. This was a huge relief to me because initially my surgeons office told me they had the medically supervised diet covered and I just had to enroll in their $400 program and I did NOT have $400 lol

Thanks for your reply. The problem is I am in a program, with dietician and cetera, and I am have the specific requirements from the insurer. And yes, indeed, any physician can provide this care. The program I am in offers me an affordable financial assistance which other programs do not.

I already called the insurer, and they told me "any physician can provide the care" and I have the very specifics of that, but my insurer could not find anyone to send me to--I am seeing the dietician as required and provided by the program, I am in, and they are covered. The missing person is the doctor to provide the medically supervised diet.

Obviously, I need to find out if I can get the medically supervised diet from another program.

Yours and thanks again

Peter

Great information artchick thank you. Unless things have changed Northwestern takes all insurance and Dr. Nagle's program. Here is the contact information give Northwestern a call.

Alexander P. Nagle

Northwestern Medical Faculty Foundation
Chicago (also in...)
Phone: 312-695-0641 Keep us posted on how things go!

My insurance also required this. It happened that I had seen my PCP a few months in a row and each time he noted my weight and that counted. My visits to the Bariatric surgeon counted for the remaining months and they would have continued to see me monthly if necessary until the requirement was satisfied.

If your program referred you to the dietician, I would just have them send a short letter to insurer saying they referred you to dietician, and have them attach dietician's records. That's a medically supervised diet. My insurer accepted such a letter.

Thanks, Mary. I have examined the specific requirements from my insurance company. It does specify that the 'supervisor' needs to be a doctor, but you raise the possibility that seeing the dietician once a month for six months might work (six visits is also a requirement). In the meantime, I have found an out of network doctor who also would work and for an affordable amount.

I toyed with the idea of joining another program (at a different hospital) and throwing myself on their mercy to let me fulfill this requirement only in their program.

Thanks again and much luck on your challenge or journey or whatever you want to call it.

Peter

Peter, I'm sure there's an "insurance person" at the surgeon's office....maybe you can speak to him/her and ask if she's familiar with your insurer's requirements. I would imagine there are others who have your insurance and have had to deal with the same issue.

Best of luck, and keep us posted.

Your

Hi Peter!

It seems to me that you need a new surgeon. Surgical programs are usually soup to nuts -- they handle the liaison with the insurance company, have prep classes, nutrition classes, support groups both pre and post op, arrange for clearances with cardiologists, pulmonologist, etc -- and the mandated medically supervised diet. Your surgeons refusal to do that is a big red flag. There are a hundred surgeons doing bariatric surgery in the Chicago area. I would make some calls and find a better program.