6 Month Doctor Supervised Diet

OK, I have to vent. I just have to so my apologies before hand. So, toward the end of February my PCP advised me I'm in the beginning stages of diabetes (lovely!) He and I had already been discussing the WLS since November. So, to start the diet he set me up with a nutrionist also at St Thomas where my PCP is. So, when the nutrionist calls to set up the appt. we talked about why I would be coming to see him. Now, I had already called my insurance (BCBS of NY) to see if he is covered and they ask why I would be going to a nutrionist and I tell them that I was just diagnosed as diabetic and they say diabetic education is covered. However, the closest nutrionist that is in network is an hour and 1/2 away! Does that make any sense at all. None the less, when I speak with Ken (nutrionist) I tell him that along with the diabetes I have to do a 6 month doctor supervised diet for the WLS. I told him that insurance tells me he is not covered by them but that I will be meeting with my PCP once a month for 6 months to follow up on my diet. He then tells me that he "thinks" the fee for the consult is $35 and that he'll call BCBS to find out why they aren't covering him. So, when I go to visit him he rushes through the diet instructions but was really aggitating me the whole time because he never addresses my concerns as an individual. He really doesn't even address the diabetic diet concerns. He gives me a pack of papers that frankly I could get the same thing from an internet search. At the end of the consult he starts telling me that for insurance to cover surgery I HAVE to regulate my diabetes and that I HAVE to lose weight. He then says that I have to come see HIM every month instead of my PCP and that insurance will require his records to approve surgery. When I bring up what we talked about on the phone regarding his fees and BCBS covering him all of a sudden I get a different story. He says "Billing takes care of all that so I don't know what to tell you". He also says it's my duty to get them to cover him and that he never has any part of that. OK, I would understand that if he hadn't given me a completely different story before. So, I don't like the guy at all! I kind of feel like it's a racket. But, I need your advice. Is going once a month to your PCP enough? When I went to the Centennial seminar, they told me that's all I needed to do. To check in with my PCP once a month and don't miss a month. Making sure he documents my weight and diet progress each visit. I just don't want to mess this process up. I have a copy from BCBS about the requirements and all it says it 6 month doctor supervised diet. But, I don't want to give them any reason to say no. As always, your thoughts are so appreciated!

What a jerk! I would feel the same way about the nutrionist! I didn't have to do a supervised diet, so I'm not sure what to tell ya. But it seems like I remember reading that a monthly weigh-in with your PCP would be just fine. I hope someone has some better answers for ya. Hang in there.

I have BCBS of TN. I went to my PCP once a month. I kept a DAILY food journal and exercise log which she signed off monthly as well as her "official" report. I submitted all the pages of information I kept along with all the medical stuff. I was approved within a week and a half. If you plan to have surgery through Centennial. You should be able to utilize the nutritionists there to help with your 6 mo. doc supervised diet. Also, their insurance specialists will be able to help you with the insurance process too. Good luck!

I hope I am wrong... but I would be willing to bet they will put a morbid obesity diagnosis on the claim, and the insurance will deny it... that's what happened with my surgeon's consultation and psych eval but anything with a dx of morbid obesity would be non covered... they finally came back after all was said and done, and covered it. but you might have to fight it.

I have Cigna and I had surgery with Dr. Spaw, his office has a form that I had my PCP needed to fill out with all of the information that most insurance requires during the 6 months doctor supervised diet. The information on the sheet included my current weight, beginning weight, lost or gained, BMI, blood pressure, temperature, blood glucose (if Diabetic) which I am also, list of obesity-related comorbities, list of current medications, diet education discussed, excersie/activitiy discussed and to list any behavior/diet goals you have for this patient. My doctor and I did this monthly, he filled this form out signed and dated it, then after six months I was approved! Originally, I was denied, because I only had four months of doctor supervised diet documentation, but after two more months I was approved. I do not know if this is the same with your insurance, but this is what Cigna required from me. Just remember all of the hoops you must jump through is completly worth it once you are approved, don't let anyone get you down. Shelia P.S. People forget, we are in control of our healthcare and we hire our medical team, therefore we can fire them as well, if we do not like what they are doing !!! (Hint Hint)