6 month diet plan

I have Cigna and a 6 month MD monitored diet plan is required.  Who is supposed to be monitoring this? Can any MD keep track of this? What needs to be documented? Ali

I have Cigna HMO and my primary care physician documented the 6 month history and I was approved in 1 week. There are other documentation that is needed such as medical records, psy evaluation, etc that your surgeons office should assist you with the information.

Hi Ali, Cigna's Coverage Position Number: 0051 is available at http://www.cigna.com/customer_care/healthcare_professional/coverage_positions/medical/mm_0051_coveragepositioncriteria_bariatric_surgery.pdf It states: "Active participation within the last two years in one physician-directed weight-management program for a minimum of six months without significant gaps. The weight-management program must include monthly documentation of ALL of the following components: ? Vital signs, including weight ? Current dietary program ? Physical activity (i.e., exercise program) ? Behavioral interventions to reinforce healthy eating and exercise habits ? Consideration of pharmacotherapy with U.S. Food and Drug Administration (FDA)- approved weight-loss drugs, if appropriate For individuals with lifelong, morbid obesity, participation in a program within the last five years is sufficient if documentation of six months is available and reasonable compliance with the weight-management program over an extended period of time can be demonstrated. However, diet programs/plans alone, such as Weigh****chers®, Jenny Craig® and similar plans, are not considered physician-directed weight-management programs and do not meet this requirement. Similarly, physician-directed programs consisting exclusively of pharmacological management are not sufficient to meet this requirement. Your PCP should be monitoring your progress. HTH, Kristen

Thanks for the good information Kristen. Is Dr. Kim considered 'in-network' for Cigna patients? I only have in-network benefits. So, basically I need to talk with a PCP regarding my plan for LAP-Band and have them begin monitoring me for 6 months before Cigna will approve. I wonder, can my Endocrinologist do the monitoring? Ali

If Dr. Kim accepts Cigna in network, that's great, otherwise, check out Dr. Jawad.  It's very important that you get the best surgeon!  I don't see why your endocrinologist couldn't do the monitoring, but the notes need to state the content of the diet discussion you had with the MD. 

Is the objective behind the 6 month diet to see if you can lose weight or to see if you can stick to one thing for that amount of time?

They want to see compliance with a medically supervised weight loss program. This is because WLS is...you guessed it...a medically supervised weight loss program.

HTH,

Kristen

Dr. Kim is out of network, but we can get a gap letter from Cigna so you can be covered at in-network rates.

Generally, a PCP does the monitoring. I would call Cigna to ask.

Kristen

Hi,  I was wondering, what if you go below a BMI of 40 doring your 6 month physician monitored diet? Is there a minimum the insurance companies are looking for you to lose? Thanks for any info, I have attended a seminar, a support group meeting, had my first Dr appt and let him know I wanted to do this and I have scheduled my appointment for my psych eval. Blessings, Linda

If you go below 40 and don't have two documented co-morbid conditions (or, with Medicare, go below 35) then you would no longer qualify (under NIH guidelines) for surgery. I would imagine that an insurance company would not pay at that point.

HTH,

Kristen