Need advice

Hi. I am just starting out in this whole process. I have had the surgeon consult, psych consult, and one nutrion consult. I have to see her once a month two more times. I have called and reviewed my insurance requirements. I do meet the criteria for BMI. No problem there. I have also developed HTN and low vit D levels recently and started on medication. I am being monitored by my doctor for this.

I dont really understand one thing in the insurance requirements. They said I need to follow a 3 month multidisclinary team approach prior to surgery. Also I read more on the insurance website. It said in within the previous 12 months prior to approval , there needs to be a 3 month medically managed weight loss program that was completed including weight monitoring, diet, and exercise and does not include weight loss medications. It said weigh****chers would count as a medically supersived program as long as if being monitored by my physican. I currently am a weigh****chers member and recently started attending meetings. My insurance is Cigna. I am not really sure how I go about this 3 month medically supervised program. I looked for programs in my area. All I can really find are programs that include medications and are really expensive. Has anyone had to do this as a requirement with their insurance and if so what did you do? I am thinkng of just continuing with the weigh****chers and seeing my doctor monthly. She said she would help in any way with the documentation. But I am not really sure what we need. Thank you for any advice or suggestions.

Find out exactly what the insurance is expecting for documentation so your doc can do it right, otherwise they could make you start all over again.

Hi,

We are at a similar point in the process.  I had my first consult last month and my insurance also requires a 3-month medically managed weight loss program. I was informed that part of the purpose of the 3 monthly nutrition consults with a certified nutritionist is to meet the medically supervised program requirement. You should verify with your surgeon's office, but your three total appointments should meet the requirement also. 

I also have to wait 3 months for my insurance, but my surgeons office told me that the Nutritionist, Psychologist and the surgeon himself would count as my multidisciplinary team. I know my surgeons office knows how to deal with my insurance due to a lot of people from my office going to see him.  Good luck!!!

My insurance required six monthly sessions with a nutritionist before the surgery. These sessions included group instruction and a little one-on-one time with the nutritionist. My sessions were handled "in house" by nutritionists on my surgeon's "team." 

My nutritionist advised me to call my insurance company and get a Case Manager there who would get familiar with my case and be able to answer my questions during the pre-op. I would suggest your doing the same. I'm pretty sure Weigh****chers (which is not medically supervised) is not what your insurance has in mind.

psychoticparrot

I had a 6mo mandatory multidisciplinary managed diet that I had to complete for my ins. Thankfully my meetings with my surgeons office they set up a pre-op diet thing that I had to follow. They required this of all their operative patients, which was honestly very useful. They had monthly courses that covered portions and "how to eat sleeved". Unfortunatly they didn't give specifics of the post-op diet which is what killed me since I had lost my ins.

But we pick up and move on. If your reporting to your physician and able to prove, through food journals and whatnot that you are following the Weigh****chers plan you SHOULD be ok.

YOU STILL NEED TO CALL THE INSURANCE COMPANY OR TALK TO THE SURGEONS OFFICE TO BE ABSOLUTELY SURE.

You should definitely call the ins & see what they specifically need, you don't want to do this all over again.

My ins is also Cigna, but what they wanted was to know what weight loss programs I have been on in the past. The medically supervised diet was to visit the surgeon & the nutritionist for 4 months, they filled out the paperwork & sent it to Cigna, along with whatever requirements my ins needed. It's probably a specific form they need filled out during the 3 months.