6-month diet/exercise plan - CareFirst

hello im going through a 12 week program and ex class through care first its done at the hospital so its good , you have to go to a program to do the weight thing for them you can not just do it and document it yourself. and im only like 90 overweight but my co mo's are getting it for me so you should not have a problem

Hi,
Thanks for the info. It's not what Dr. Schweitzer's office told me when I called. They said 6 months diet and exercise program supervised by physician. 

Do you have details on this program? If so, please send! CareFirst had no clue what was required when I called them, they even tried to look it up for me, but couldn't give me any more information than what's on the website.

Thanks!

make sure he covers carefirst blue choice someone says he doesnt , you can go to any class and do it for six months but its better if done by a doc. my doc has a program at the hospital so its a 12 week program for me because i have been through these hoops more than once. he accepts it and is world known as one of the few whom actually do the reversal on it.

one is the bariatric course, and the exersise classs, then the phys. and the nut, then the ekg and sleep aphnea test, then insurance approval i have carefirst bluechoice open acess there is a difference in carefirst programs which do you have

I have Blue Preferred. I would like to know more about the class you say Care First has at the hospital.

Thanks.

its not carefirst's program its the hospital that my doc works out of franklin square

Hi,
Every insurance is different, and the best way to get accurate info is to call the number on the back of your card and to discuss the requirements with the insurance coordinator at Dr Schweitzer's office.  She knows all the various policy requirements.  Also, talk to your HR dept and get a copy of your insurance explanation of coverage and any clauses added at the end allowing coverage for WLS. 
Once you find out whether it's 3 or 6 months of physician supervised weight loss/monitoring required, you can begin having your Dr. or nutritionist document, if you haven't already started to, each month a weight, notes discussing nutritional counseling, and noting exercise you are doing.  The nutritionist should know what to document for you.  Insurance Companies want notes from a professionl, not from the patient.
You have to be seen once in each calendar month for it to count.  Go in even if you're sick so you won't be required to start over to get the consecutive months.  I learned that the hard way. 
What the criteria state is that you demonstrate failure to lose your excess weight under a physician supervised program.  It's a fine line and every insurance reviewer seems to think differently about it.  Some think you should be able to lose some weight, and if you don't, they think you're not compliant with the program, while others acknowledge that if you do lose, it comes back soon and therefore you need the surgery. 

If you have an eating disorder, that will be discussed at your psych evaluation, and they may require you to get treatment in the group eating disorders program they have a Bayview, or to tell them who you are seeing for treatment now, and what you plan to do to maintain treatment and stay well. 

Thanks, Jennifer. It's good to hear from a Schweitzer patient. My HR office and I have gone over all of the paperwork, that's when I pointed out the exclusion they had no idea was there! The insurance company (on the back of the card:) has no information beyond what they have on their website about the diet/exercise plan, so hopefully Schweitzer's insurance coordinator will have a better idea. My doctor and I are meeting monthly about this, and he's having me take daily weights, blood pressure, food diary, exercise log, etc., and I'm meeting with a nutritionist for the "diet plan".  I know they have an excellent cognitive behavioral therapy program at Hopkins for binge eating, even though I have a therapist here, which is great, because the best person here is ridiculously expensive and doesn't take insurance. I've already been intreatment for years for my eating disorder, but hopefully further meetings will help with this more.

But since there's a company exclusion, unless the policy changed, I may be forced to go to Mexico!

I am just a little concerned about losing too much weight, because I have a fairly low BMI to begin with (around 38).

Hope everything goes well with your surgery. That's very exciting!