Insurance issues

Carefirst BC/BS is now making you provide documentation of six months supervised program. Does anyone have any suggestion.

Hi Sharon, I wish I had some magic words of wisdom to help. The best I can offer is that if your insurance carrier requires the six month supervised weight loss...call your PCP and get it going. I know every day before surgery seems so long, but you can be doing the other stuff you need to do while the clock is ticking on the six months. If you choose to do nothing, six months are still going to pass by Please don't think I'm being sarcastic...I'm not. Don't let a six month delay derail your efforts to get WLS. As always, you can drop in here to rant, rave and ask questions anytime. Take Care, Terry

Thanks Terry. I'll do that.

have you been doing things like curves or golds???? That might help or have u tried submitting notes from your PCP showing that you have been consistantly trying to loose weight for sometime not nec 6 solid months but over the years....find out who the case manager is and plead your case with them. Find out what else would be accepted as proof of weight lose attempts like weigh ins from gyms, weigh****chers etc, etc..... My husbands insurance, BCBS Highmark also has a 6 month supervised rule. He unfortunely had nothing like i mentioned above, but found out if he had we could have had the 6 month rule overrode...........Good luck and keep me posted

Call your PCP and get those appointments scheduled. Make sure your PCP documents your weight, hirght, BMI, and any discussions you have regarding weight loss and dieting on EVERY visit. Also, do not let the appointments run over 30 days apart. The terminology of whats required should read 6 months CONSECUTIVE physician supervised weight loss program..... or something to the effect, but the insurance companies will make you repeat the 6 months if any one of the appointments runs past 30 days. My suggestion is to schedule them every 28 days. I had to repeat mine and it was no fun, believe me, it's worth it to get it right the first time. Best of luck to you, Roni

The exercise programs that folks mentioned won't count as a medically supervised diet program unless there was a licensed nutritionist on the premisis that you saw once a month while you were attending the gym. The key words are DIET and SUPERVISED. So for instance, an on-line program wouldn't count either. Not exactly supervised. One of the reasons we went that route was so that folks wouldn't be hurt by fad diet programs or do-it-yourself programs. You need to see and be seen by a heathcare professional (doctor, nutritionist or even an eating disorders program) once a month. Make very sure that they record that you are on a diet to do something about your obesity. Even if you do go to the appointment and they neglect to write it down, the insurance company will make you start all over again. No one expects miracles from the diet program. What they want to know is that you gave dieting an honest try first and that you are willing to make a lifestyle change. There are some doctors out there that expect a certain weightloss during this period. But that is the doctor not the insurance company, ususally. Good luck with the diet program. Michelle Engelmann Vice-Chair Maryland State Task Force to Study Utilization Review of the Surgical Treatment of Morbid Obesity

I have been on several programs with my physican however the one's that seem to work cause me more harm than good. I am a mirgrane suffer and the meds for weight loss cause my headached to worsen and my pressure to elevate even higher and they are very expensive. I've been on low fat, low cal and low carb a countless amount of times but no real results. I've gone to gyms for years and still no real results. Up a couple of pound and down a couple of pound. Well, I've turned in my verifications from the gym and from weigh****chers which was a waste of money for me, and money that i struggled to even come up with then. This is just getting very upsetting for me because I can't afford those cost associate with the programs and my co-pays have gone up this year for my primary. My health just continues to get worse and it hurts my heart and mind. I work in an area were I see people abuse and misuse the systems in every shape for and fashion and nothing done. Then there are people who live right, work hard and be honest and try to do everything the right way and all we get is a hard way to go when we in need. I appreciate you response and maybe by monday or tuesday I'll get my approval or denial from the insurance company.

Hi sharon I am so disappointed myself. I am also dr roe's patient. My original appt was for the 13 th and his office rescheduled me. I would have raised h*** if I knew this policy was going into effect. I was told several times that a 6 month diet was not needed. Low and behold my appt was on the 20th and I too was asked for additional infomation concerning a six month history. I could scream. I hope the infomation you provided will be enough for you. This whole process can be so unfair. Keep us informed

I understand exactly how you are feeling. I called Carefirst in January 06 and they told me they didn't cover it (when now I find out they did cover it). My first weigh****cher attempt was from 1/04-9/04 and the first 7 months is now outdated, when it would have been in the date range if carefirst would have given me the correct information in January. However I did attemp weigh****chers again last year but I am shy of about 2 or 3 week from having six months. However I did go to curves for 18 months and my pcp tried me on a few diet pill so we'll see. Those diet pills made my head hurt. Well thanks for the response and I hope all goes well for you too. I met you in the office that day...remember?

Hey sharon. I remember you. Looks like we are to peas in a pod. If anything good happens for me I will definitely let you know. Isn't that something. Things change just when it is our turn. You know I am going to fight this because I called them several times before my appt and they said no such thing or I would have made sure somebody submitted my paperwork because I had it ready. Are you still going to the picnic. I was going but if I don't get good news this week I probably won't. My stomach is turning flips and I don't think I would be able to stomach the despair.