6mo PCP supervised diet & exercise?

Hi All,

I started the WLS process in early June with WLIAZ and after submitting to insurance (AZ Foundation) was told I need to do 6mo PCP supervised diet & exercise.  Any ideas as to what the insurance company will be looking for in my chart.  Also, I see a nurse practitioner do you think that is ok?  I found her in early May and she is the greatest...so supportive of me going in the WLS direction.  She is of course recording my weight, exercise, diet and any life stresses (such as my back going out) that would affect my weight loss.  She told me if i can think of anything else that would help to let her know and she will put it in my chart.  Any advice?

Thank you,

Jeannie in AZ

Im up in Flagstaff and am going through the program with Flagstaff Medical Center. They have a bariatrician program whi*****ludes all the nutritionist education, psychology evaluation, Cardiac evaluation and 6 months of weigh ins. I also had to do a bunch of labs incluidng a poo test for h pylori. This is all that he does, so he has become an expert in documentation for the insurance requirements. You may want to check out where you are having your surgery to see if they have a similar program. You can also call your insurance and ask them to send you a copy of their policy and requirements so that you can check them off as you go. Good Luck to you!!

Thanks for the advice my program sounds very similar to yours.   I too have done all the tests you mentioned and then some however according to my insurance the 6mo PCP diet and exercise program can not be affiliated with my bariatric surgeon which to me is just ridiculous.  I'm told because my insurance is self funded via my employer its just a stalling technique to weed out those who are not commited or are willing to make a change in lifestyle...Thanks again!

Hey Jeannie,
I also had to do the 6 months diet supervised by my doctor. Basically I just went in once for 6 months for the sole purpose of checking in. Don't discuss anything else with your Dr during this time because you need your "reason" code that is billed to your insurance to be weight related. I learned that the hard way almost as I had talked with my Dr about a rash in my apron area once and it was logged as something other than weight and the insurance almost didn't take it!!! Now, what did each time is when I got weighed before I had the MA do anything else I always asked her to please make a note of my weight in the general notes section and indicate any gain or loss clearly. The reason I did this is that often times when the charts are hole punched at the top parts of your check in info can get punched and yep, that includes your weight!! Next up the Dr would come in and I would start off by letting them know I am doing my monthly check in and talked about what I had been eating and what exercise I was doing. I talked about what seemed to be working and what wasn't working etc. Most Dr's will be detailed if you are detailed. Just letting them know what you are coming in for will help them understand that you are relying on them for great notes. Good luck. It took me a while but I did get approved for RNY last May and had surgery in June! Best decision ever!!

Nicole

Thanks for the advice Nicole I will definately make sure I am specific and give details congratulations on your surgery and wish you much success.

Jeannie

ya dont do too well - they might say- see you can do it on your own. LOL  Really tho. I went thru it . .

Kristi