I'm confused about my 6 months of supervised dieting..it's not actually 6 months...

Lisa_67
on 9/4/08 10:11 pm - Ravenna, OH

When I went in for my first appointment with my surgeon(Dr. Dan), I was scheduled for 6 appointment with my Dietician, 1 a month from Sept. 6TH to Feb. 3RD. But, it is actually only 5 months of dieting. I called Dr. Dans office and I was told that the way I was scheduled, is the way they do it. I understand that, but what about my Insurance Company? I'm just worried that they won't accept that and I'll be required to either give them another month, or start over. Am I being silly, or should I just shut up and trust my surgeons office??? Thanks!

starting weight...307 Surgery weight..274 Onederland...198 (3/6/10)
I lost 33 pounds before surgery. My new life has finally began

(deactivated member)
on 9/4/08 10:17 pm

RNY on 03/04/09

I scheduled 7 appointments. And I had to schedule them with my primary physician and not a dietician. (I have Cigna)

I was going to ask this question too, but I figured Id be safe and do a full 6 months with a visit on day one and a visit on day 180.

here are the actual guidelines from CIGNA

CIGNA HealthCare covers bariatric surgery using a covered procedure outlined below as

medically necessary when ALL of the following criteria are met:

•

evidence of one of the following:
The individual is ≥ 18 years of age or has reached full expected skeletal growth AND has
��
BMI (Body Mass Index) ≥ 40 for at least the previous 24 months.
��

clinically significant comorbidity, including but not limited to, cardiovascular disease, Type 2

diabetes, hypertension, coronary artery disease, or pulmonary hypertension
BMI (Body Mass Index) 35–39.9 for at least the previous 24 months with at least one
•

program for a minimum of six months without significant gaps. The weight-management program

must include monthly documentation of
Active participation within the last two years in one physician-supervised weight-managementALL of the following components:
Page 2 of 34

Coverage Position Number: 0051

��
weight
��
current dietary program
��

Programs such as Weigh****chers

done in conjunction with physician supervision and detailed documentation of participation is

available for review. For individuals with long-standing, morbid obesity, participation in a program

within the last five years is sufficient if reasonable attendance in the weight-management program

over an extended period of time of at least six months can be demonstrated. However, physiciansupervised

programs consisting exclusively of pharmacological management are not sufficient to

meet this requirement.
physical activity (e.g., exercise program)®, Jenny Craig® and Optifast® are acceptable alternatives if
•
Evaluation by a multidisciplinary team within the previous 12 months whi*****ludes the following:
��

treatment
an evaluation by a surgeon qualified to do bariatric surgery recommending surgical
��
a separate medical evaluation recommending bariatric surgery
��
clearance for surgery by a mental health provider
��
a nutritional evaluation by a physician or registered dietician

Mandy_
on 9/4/08 10:20 pm - cincinnati, OH

RNY on 07/22/08

I had my first diet appt on Jan 24. second mid Feb, 3rd mid March, switched surgeons 4th mid april, 5th mid may and 6th june 20th. counted as 6 months. my paperwork was sent in late june and I was approved like july 2nd.

Mandy, Mom to Jordan (5), Kaida (3) and Luken (born 12/5/09) Army wife! HW:351 / SW: 328 / CW:149/ Goal weight...what is that?

Lilypie - (Q3jk)

Lisa_67
on 9/4/08 10:29 pm - Ravenna, OH

RNY on 09/01/09

Maybe it just depends on the Insurance Company. When I was talking to Bev, the Financial Director, she said that Buckeye requires 6 months, then she looked at a calender and said that we'll be ready to submit everything to Buckeye in Feb. Seemed a bit odd, but I didn't say anything until today. I guess I'll just wait and see, cause I am going through my surgeons office instead of my PCP..I'm sure they know what they're doing..lol They are the professionals.

Thank you both!!

starting weight...307 Surgery weight..274 Onederland...198 (3/6/10)
I lost 33 pounds before surgery. My new life has finally began

Mandy_
on 9/4/08 10:41 pm - cincinnati, OH

RNY on 07/22/08

I was nervous like yourself. it was explained to me that Jan counted as a whole month just because I was seen in t hat month. sounds like your feb would too.

good luck and keep us updated

Mandy, Mom to Jordan (5), Kaida (3) and Luken (born 12/5/09) Army wife! HW:351 / SW: 328 / CW:149/ Goal weight...what is that?

Lilypie - (Q3jk)

Lisa_67
on 9/4/08 10:45 pm - Ravenna, OH

RNY on 09/01/09

Thanks..I will!
What actually got me freaked out was, I had made a new ticker counting down my 6 months, and it only came out to 4 months, 4 weeks and a few days. I called my doctors office right away..lol I guess I'll post my ticker even though it doesn't start til next week...

starting weight...307 Surgery weight..274 Onederland...198 (3/6/10)
I lost 33 pounds before surgery. My new life has finally began

Martha C.
on 9/5/08 12:18 am - Ellet, OH

RNY on 12/10/08

My first visit to Dr. C was in April, didn't start WW until 5/6 or something. But they are submitting the paperwork mid October. Look at it this way, if they turn us down (I have Medical Mutual) for not having 6 months, you'll only have one more month to get the approval! A lot less time than the 6 months to begin with! And if that's the only reason for the denial, you know you'll be in like flynn in just one more month!!

Ruby3901
on 9/13/08 8:11 am - OH

I have Dr. Zografakis as my surgeon and was also put on a six month physicians diet program due to requirements of my insurance company. The end of October will be the end of my six months. I have finally completed all the testing and now have two more visits with Dr. Wells before seeing Dr. Z and submitting to the insurance company. Bev is great I had questioned them about the six month requirement since we had not submitted for the surgery yet. The office has been through all the insurance companys and knows ahead of time what will be required. (I have BCBS of Illnois) Which surgery are you going to have? I have decided on the sleeve and am keeping my fingers crossed that the insurance company will pay. I also know I will have one month of the opti fast liquid diet before the surgery. The opti fast is going to be kind of expensive but I figure I wont be spending the money on food so maybe it will even out. Not really looking forward to that but at this point I'm determined to loose the weight. I hope to have the surgery the end of November or maybe December but thats just speculation on my part. I have spoke to Dr. Dan and he is in the same practice as Dr. Zografakas. Good luck to you and keep a positive attitude someday it will have been worth all the hard work.

I'm confused about my 6 months of supervised dieting..it's not actually 6 months...

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I'm confused about my 6 months of supervised dieting..it's not actually 6 months...