Newbie with first question RE: 6 month sup. diet

Hi everyone! I am a new member and am just beginning the process to make sure I have what my insurance requires before I submit. One of the requirements is a 6 month supervised diet attempt. The policy specifically states:   

Active participation within the last one to 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. Most of this I understand with no problems. I acutally had my first visit today with my PCP and he was very supportive and seemed to write everything down, so I see that as a positive. The one thing I do not understand is the Behavioral Interventions. What specifically does this mean? Is simply talking about how I am changing my behaviors enough? Or does this mean support group meetings? Psychiatric or psychological help? Does anyone have any experience with this part of it specifically? If it helps, my insurance is Cigna Open Access Plus. Thank you! April

it really depends on your ins co. and how much of a PITA they decide to be for this process.... in most cases,  Behavioral interventions to reinforce healthy eating and exercise habits will mean a visit or two with a dietician to educate you on proper food choices, proper instruction on how to read food labels, etc....... and/or a visit or two with an exercise physiologist (EP) which, in simplest terms, is an over-educated personal trainer LOL.... seriously though, an EP is someone who can, among other things, instruct you which exercises to do for best results... and HOW to do them so that you don't get injured, frustrated or discouraged.

Hi April: I have BCBS and I specifically asked this question of my insurance company.  I asked if I needed to see a psychologist or something similar.  They said no, just needed documentation that you were working on changing your eating patterns and that you were aware of what you needed to be doing to maintain a health diet.  What I did was see a nutritionist about 4 times during the 6 month period and my PCP looked over her notes and integrated the nutritionist's recommendations in the monthly progress notes.  I got approved, so it must have worked. Hope this helps and good luck,

These ideas are all great, but how do they get documented on my monthly visits to the Doctor? Do I just tell him what I'm doing and ask him to make note of it in his records?  It is hard knowing that everything hinges on this 6 month supervised diet and I have to trust that my Doctor is documenting it all to the satisfaction of Cigna.  april

I would just ask the doctor for a copy of one of the progress notes and then you decide if he's leaving anything out and request that it be added.  Many PCP's have not had a lot of experience with WLS and insurance requirements and do not know exactly what has to be documented unless you tell them.  It is to your advantage to be pro-active in this situation.  Make sure that what you need is documented in your record....although the 6-months pass fairly quickly, you sure don't have to have to do that more than once!! 

I'm sure that keeping a daily/weekly journal on your own would help you remember what you're doing.  Then show this journal to your PCP each time you visit so they can see the proof that you are working on changing your behavior.   Or if you're keeping a food log, just include these notes with that information as well.   I know that FitDay has a journal section where you can write notes, thoughts or goals along with keeping track of your daily food intake, exercise, weight tracking and measurements.  Just a thought, Pam

I used a document that was on [email protected] .  I have 7 months of documentation as one of them needs to be the initial consultation.  Cigna wants 6 "complete" months of the supervised diet and you do not want any bumps in the road.   Your doctor will need to advise you of the dietary plan best for you.  Mine was that I did low carb, high protein and allowed for only 1200 calories per day followed by exercise.  My exercise plan was walking as I have athrithis in both my knees and one hip.  Added to that I went to my nutri for 6 months to reinforce the behavior modification. All of this will be documented by your PCP and when submitting, all notes from PCP, nutri, psych and surgeon will be sent in for approval.  Make sure that your PCP is stating you are compliant with the program each month.  A letter from your PCP to your surgeon will need to state why he/she is recommending you for WLS which needs to include your medical history, etc. I have Cigna and have just submitted all my paperwork in.  If you need to, please email me at [email protected].  I'll help any way I can.

It is meeting with a Dietician monthly.