Insurance and Diets

Hi, Im fairly new to this board and absolutely love all the help and guidance Ive received so far.  Thank you to everyone whether you know you've helped me or not. I really appreciate it. I am a DS pre-op and have some "disconnects" about my 6 month diet.  Optimum Choice requires a 6 month diet.  I have 9 months of Weigh****chers meeting their requirement and am actually going now too (I guess I like to waste money?).  My problem is that I have gotten a few different answers on the format I need to submit my WW diet history.  I assume it needs to come from my PCP but I need to let them know how to send it.. with a letter? by itself? Just the "book"?... Opt Choice has been little help by just telling me they need it and not HOW.  I am trying to be as effective in submitting as possible and giving them exactly what they want right up front. ... I guess its the insurance agent background in me. SO.. if you have Optimum Choice HMO in Maryland, could you please let me know what format your diet history was sent in? Ive got my nut and psych appointments in the next week in a half so I want to be as prepared as I can be with insurance Thanks in advance for your help! Teri

Teri, They may not require "perfection" in terms of your record-keeping.  I think it all depends on the insurance company and I don't have Optimum Choice.  I will tell you this: my insurance (GEHA) allegedly requires a 6-month diet.  When I had my initial consult, I was on the 3rd month and didn't have any other recent diet history.  Other than that, their rule is 35 and 2 co-morbs or 40.  My BMI was 49.9 and I had 4 or 5 co-morbs, though all well-controlled.  Dr. S. was skeptical that I would be approved on the first try, but thought we should go for it. What I was able to do, after some research in the insurance area of OH, is to write up a 27-year history of failed dieting and loss/regain.  I was able to say things like, "Between May 2000 and June 2001, I participated in the xxx program and lost xx lbs., weighing xxx when the program concluded.  By December 2002, I had regained ...."  I wrote out about a 3-page history and gave it to Dr. S.  I also gave a copy to my shrink so the same info could be reflected in my psych eval.  I don't know how Hopkins presented all this information to insurance, and indeed, I got the impression that they would hold back the big guns for an appeal, but I was approved on the first submission.  Without a 6-month diet.

I hate that wait but it does go by fast. I just finished mine. I will tell you that my insurance requires it , but mine has to consit of 6 dif   letters one for each month.  I also so know some one else who had doucmentation and it wasnt from her PCP it was from a gym. I hope this is of some help and of course some insurances are diefferent. Good luck on your journey. Take care Ann..

Well, I went ahead and faxed my WW  "book" with the 9 months worth of it over to Dr S's office.  I dont know if thats exactly what they want/need at this point or not but they have it regardless.  I guess they will let me know.  My primary care doc has it too, so I guess they will sort it out and re-get it from him if they need to.   I am probably worrying too much and reading more into it than it is but.. Being in the insurance industry, to me its just much easier to have everything ready up front to reduce the risk of denial. Thanks for your help and best wishes to you in your weight loss journeys Teri

You are doin it right girlie!!!!!!! The book is all they need. Let Dr. S send it in with all the paperwork for the insurance. Relax!!!!!!!! You are doing everything great!!!!! Who did you find for the psyche????? No more WW for you!!!!!!!!! Jennifer

The psych I am using is Dr Gergely.  He is in Dunkirk, which is a bit of a hike, but not near as far as Baltimore or above.  Ill keep you posted as soon as I go how it turns out.  My appt is the 29th Teri

Teri where is White Plains. And I would like to invite you to stop over on the DS board when you get a chance. They have lots of specific experience for DS'ers. I love posting on the MD board too though!!

Hi Teri, I have optimum choice as well. It was fairly easy but my cir****tances are different from yours, I went to my PCP to get a referal to the Dr. I wanted to have my surgery with. He gave me the option of completing my 6 month diet w/ him or my PCP, I completed it w/ him. He sent out all my paperwork, shrink eval, nut eval, diet history and all other supporting docs.  I think w/ WW your PCP has to send all the info. to your surgeon ( w/ the referal ) and he will submit to insurance for you. All in all it took 4 days from the date the paperwork was sent until I got my approval. Best of luck, it should go pretty smooth for you.  Christina

What a fabulous picture!!!!!!!!!!!!!!!!!!!!! Jennifer

Jo, White Plains is right below Waldorf, in southern MD, Charles county.  Ive been lurking on the DS board. Its been VERY helpful.  I cant seem to stay away from it and get any work done these days. Christina,  thanks so much for the Optimum Choice information.  I faxed Dr S's office the WW book, but I do suspect that they (or someone) will want it coming from my primary's office too.. and thats fine because they have it there too.  What happened to the 48 hour turnaround Opt Choice tells you it will take? yeah, right! LOL Jen... yeah, the pic doesnt look at all like me huh? haha