Question:
proof of diets
How do you show proof of diets you have been on to the insurance company and the hospital? I have dieted where you cut back on calories and excersise but have never really tried any of the commercial diets because of costs and knew that I would gain the weight after I stopped them anyway. My pcp knows that I have attempted numerous times to lose weight and have a hard time because of the meds I am on for bi-polar. I do show in my charts that I have lost and gained, will this count as diet attempts? — LindaD. (posted on March 28, 2008)
March 28, 2008
your file with your pcp or a dietician were the ones that my insurance
company was looking for as proof. However you need to ask this question to
your insurance company since they are all different and you have to meet
their specific guidelines. My insurance company changed their guidelines
part way through my 6 -month documented weight loss program and decided I
didn't need to comply with this....a very fortunate for me decision however
they can be real difficult too. So find out what is specific to your
insurance and good luck.
— cjjordan
March 28, 2008
Insurance companies vary in what requirements they want met before they pay
for WLS. I met the co morbid conditions because my BMI was under 40, at
39.5. They also required document proof of a medically supervised diet
partipation of at least 6 months duration within the past 5 years. I had
surgery in May, 2006, and I'd participated in a program of 8 months
duration in 2002. I approached the manager of the program of 2002, and had
her draft a letter acknowledging my particpation in their program. This got
me out of a specific diet regimine program, but I still had to partipate in
a nutrition educations and RNY information class several weeks in duration.
My classes were 8 weeks long, but were changed to 22 weeks for those who
entered the next nutrition class. You need documented proof, and you may
still need to particpate in another program within your insurance company.
Most insurance companies just don't authorize a 30K surgery at a moments
notice.
— Dave Chambers
March 28, 2008
What they will want to see is a record from your PCP where you had your
weight and BP checked and when there at least every 3-6 months, and notes
from the doctor's file that you were trying to diet without much success.
The PCP in a HMO is the guy that can get you in to a WLS program or keep
you out. If you have to start over because the PCP will not cooperate,
start with a new PCP and make sure he or she knows why you came to them.
Then after 6 months the insurace company will review his records.
— William (Bill) wmil
March 29, 2008
I was suprised to find out that Weight watchers and nutrasystems Did not
qualify as weight loss programs under their guidelines. They wanted my
doctor and a registered nutritionist...which i did not do. My medical
charts over the years have showed my ups and downs so we are hoping that is
enough.
— [Deactivated Member]
April 1, 2008
YES. THIS WILL HELP EXPEDITE MATTERS FASTER. THEY HAVE TO TAKE THIS
INCASIDERATION, THIS SHOWS THAT YOU HAVE ATTEMPT FOR A WHILE TO LOOSE
WIEHGT WITH THE HELP OF OTHER . IF THIS HELP HAS STILL FAILED YOU THE LAST
RESORT IS WLS, WHICH THEY CANT DENY YOU IF SO FILE THE APEAL, AND A
COMPLAINT BECAUSE THEY CANT DENY YOU IF YOUR DR, RECCOMEND IT MEDICALY
NECCESARY.
AS FOR MY SELF. WHEN I FIRST WALK INTO MY DR. OFFICE FOR THE CONSULTATION
I HAD BROUGHT WITH ME 6 YRS OF ME GOING BACK IN FOR TO WIGHT WATCHER, JENNY
CRAIG, NUTRA SYSTEM, LA WEIGHT LOSS, AND A WEIGHT LOSS DR. ALONG WITH 10
OF BEING ACTIVE AT THE GYM. I CAME PREPARED THAT DAY AND I WALD OUT THE DR.
OFFCE WITH A 2 MONTH SCEDUAL DATE FOR SURGERY THAT SAME DAY. OF WHICH MY
INSURANCE COULDNT DENY ME BECAUSE EVERYTHING THE WOULD RECCOMEND ME TO DOE
WAS DONE IN THE PAST ASWELL AS THE CURRENT. I WAS APROVE IMMEDIATLY
— yvettetas
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