6 month monitored weight loss

Noahsark2006
on 1/7/16 9:46 pm

Hello... I have been doing the requirements of my insurance for bariatric surgery. The insurance gal for my surgeons office was the one walking me through and monitoring the things I have done to get ready, she apparently is no longer with them so I got a new insurance gal. I am about to do my 6th month of "monitored diet" which is the last thing I have to do. The new insurance person said that I have to see the dr every month when I weigh in , for insurance to approve. I have been seeing the dr about every other month, but once or twice I have just gone into Drs office to weigh in and they put it in my chart... I am now concerned that they are going to deny me because of this... i will see if I can figure out how to attach requirement sheet to this post or in comment:  , hoping someone has been through this and found it wasn't an obstacle. I have been seeing dr , but have not seen her on every weigh In at the Drs office! 

RNY0615
on 1/8/16 6:32 am

All insurance companies and programs have different requirements. Mine had a form that needed to be filled out (my surgeon's office gave it to me, but it was for  my doctor to fill out). If there is a similar form for you, I assume the doctor could fill out those dates that you came in just to weigh if they felt so inclined. HOWEVER- your insurance company would know if you actually went for a visit or not because they're the ones that get billed. 

The thing to do here would be to talk to your insurance company about it and see if they'll accept it. I don't think anyone else can answer this for you. 

L. 68
on 1/14/16 3:27 pm

Yes Definately call your insurance yourself,  i went to see my doc regarding revision (from band to sleeve ) on Monday January 11 and the visit went well and quick since i have been a patient of his since 2006 but his new coordinator doesn't seem to know much yet she kept telling me i have to go have 6 month nutritional visits blah blah blah because alot of insurance policies has changed. well i was upset about that because when i had my lapband in 2006 (same doctor,same insurance) i didn't have to go through that..  well she continue to give me all the requirements and i kept telling her that my insurance is not requiring anything so she said she would find out ( well i asked her to find out) because at this point i was upset and didnt want to hear anything else about 6 months NOTHING....so i yessed her and then left.... when i got to my office i couldn't wait so i called my insurance myself and VOILA! i was right i have no 6 months nutrition visit or scale visit to do..  so relieved so i called her and told her and also gave her the direct fax number to submit my PREDETERMINATION letter.    I still have to do the regular visit post op, upper GI xrays ect. which i already have scheduled for the 25th of this month so after that doc will know if he is going to take out the band and do the sleeve at same time or not.. Just take one day at a time and do your own research and ask questions pertaining to you not anyone else's insurance like my coordinator did.  BEST OF LUCK skinny thought sent your way.

R.

Jobsies
on 1/8/16 5:05 pm - Pitman, NJ

It's been years -- but when i was trying to get approval, the insurance denied me because one of my visits i also had a cold - they said that my cold was the "primary" reason for my visit and not obesity so they denied me.  That was my second denial, the first one was that weigh****chers (which is where my dr told me to go for an approved program) was called a "fad diet" and not "dr supervised" by insurance.

 

I ended up hiring a lawyer to get it approved...




14 pounds lost before surgery. My first ticker is when I hit onderland: this was my goal when I started on this journey.  I want to focus on that right now...once I get there I can reevaluate.

My second ticker is my dream goal. Even if I only visit there for a short time, it would be nice to see that number just once.  I am pretty sure I'll need plastics to hit this goal.

            
Han Shot First
on 1/8/16 6:41 pm - Flint, MI
RNY on 10/06/14

When I had went through my six month period, I didn't see the doctor at all, but I did meet with a dietitian each time.  I hope that things go well for you and your situation.

--

150 lost and maintaining!

Doingrightin2015
on 1/9/16 2:39 am
RNY on 03/10/15

When I was going through all of mine I did it all through the Bariatric Center. I went every 4 weeks and saw the NUT and either the Dr, a CNP or PA each visit. Then right before surgery I had a to have a pre-op physical from my primary doctor. The center  I went to knew what all needed to be done and how. Mine really went very smoothly.

Doingitright2015

HW in life 282 HW265 at start SW 244 CW170

 

 

 

 

 

 

(deactivated member)
on 1/15/16 10:47 am

I got nailed by this as well.  I had a long list of appointments, but they were insufficient.  My bariatric doctor gave me a sheet which I made seven copies of for my primary care physician.  For my insurance (many differences), I need seven appointments.  The first kicks off the clock and the next six need to be more than 30 days apart (yup, 28 days is a no go even in February).  My physician fills out the form, documents my nutrition, exercise, weight, etc., and codes the visit for morbid obesity (my previous appointments did not have this coded).  So far, I've received better care during this period than any other time with A1C dropping from a 10 to 5.7 and having gone from 270 to 232 pounds.  Luckily I don't have a 'check the block' physician.  For me, I need to get the behavior worked out if I'm going to have any success whether medical or surgical.  Most are waiting for my eventual yo-yo.  Wish you the best in your endeavor!

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