HELLO-QUESTION???
Kendra D
on 4/6/07 1:23 am
on 4/6/07 1:23 am
I have United Healthcare. When I called the insurance company to found out their requirements for RNY they told me that they require physician supevised weight loss but they won't tell me how long I will need a "physician supervised diet". Does anyone know how I can get this information out of them. For example I don't want to do the 6 month if they only require 3.
Also, does anyone know what the insurance company requires in the doctors actual office notes for the diet? I work for the doctor that is doing my supervised diet and she doesn't know what they require.
Thanks,
Kendra
From what I have read (we currently have BCBS but have the option to change to UHC in the near future, so I have been reviewing them both) and what I have found is the following (this is pasted from their bariatric surgery page):
Patient selection criteria include:
Failed medical therapy including physician-supervised treatment with low calorie diet, lower fat diets, alteration of physical activity patterns, behavioral therapy and pharmacotherapy. NHLBI recommends that at least six months of frequent medical visits of at least once per month and preferably more often to supervise combined dietary, physical activity, and behavioral therapy. Lifestyle change strategies should be attempted prior to the initiation of pharmacotherapy. (Documentation of a structured diet program includes physician or other health care provider notes and/or diet or weight loss logs from a structured weight loss program.)
Completion of an assessment the patient's motivation for weight loss therapy whi*****ludes reasons and motivation for weight reduction, previous history of successful of weight loss attempts, family, friends and work-site support, the patient's understanding of causes of obesity and how it contributes to disease and capacity to perform physical activity and time availability for weight loss interventions.
Active participation in an integrated clinical program that involves guidance on diet, physical activity and behavioral and social support prior to and after the surgery.
Other indications for patients with BMI between 35 and 40 include obesity-induced physical problems that are interfering with activities of daily living (e.g. musculoskeletal, neurologic, body size problems precluding or severely interfering with employment, family function and ambulation.)
Presurgical assessment should include a comprehensive medical evaluation before the operation. Evaluation by subspecialists (cardiologist, psychiatrists and psychologists ) is not routinely needed.14
Clinical evidence supports the use of open or laparoscopic bariatric surgical procedures as described above for adults with BMI between 35 and 39.9 with any of these qualifying comorbid conditions2:
Established cardiovascular disease such as history of stroke, myocardial infarction, stable or unstable angina pectoris, past history of coronary artery surgery or coronary artery procedures.
Hyperlipidemia uncontrolled by pharmacotherapy.
Type 2 diabetes uncontrolled by pharmacotherapy.
Hypertension uncontrolled by pharmacotherapy.
Moderate to severe sleep apnea with a respiratory disturbance index (RDI) of 16 to 30 (moderate) or apnea-hypopnea index (AHI) >30 (severe) as documented through the completion of a laboratory based polysomnography.30 (For further information on sleep apnea, refer to the medical policy on Polysomnography for Evaluation of Sleep-Disordered Breathing.)
Good luck.
Patient selection criteria include:
Failed medical therapy including physician-supervised treatment with low calorie diet, lower fat diets, alteration of physical activity patterns, behavioral therapy and pharmacotherapy. NHLBI recommends that at least six months of frequent medical visits of at least once per month and preferably more often to supervise combined dietary, physical activity, and behavioral therapy. Lifestyle change strategies should be attempted prior to the initiation of pharmacotherapy. (Documentation of a structured diet program includes physician or other health care provider notes and/or diet or weight loss logs from a structured weight loss program.)
Completion of an assessment the patient's motivation for weight loss therapy whi*****ludes reasons and motivation for weight reduction, previous history of successful of weight loss attempts, family, friends and work-site support, the patient's understanding of causes of obesity and how it contributes to disease and capacity to perform physical activity and time availability for weight loss interventions.
Active participation in an integrated clinical program that involves guidance on diet, physical activity and behavioral and social support prior to and after the surgery.
Other indications for patients with BMI between 35 and 40 include obesity-induced physical problems that are interfering with activities of daily living (e.g. musculoskeletal, neurologic, body size problems precluding or severely interfering with employment, family function and ambulation.)
Presurgical assessment should include a comprehensive medical evaluation before the operation. Evaluation by subspecialists (cardiologist, psychiatrists and psychologists ) is not routinely needed.14
Clinical evidence supports the use of open or laparoscopic bariatric surgical procedures as described above for adults with BMI between 35 and 39.9 with any of these qualifying comorbid conditions2:
Established cardiovascular disease such as history of stroke, myocardial infarction, stable or unstable angina pectoris, past history of coronary artery surgery or coronary artery procedures.
Hyperlipidemia uncontrolled by pharmacotherapy.
Type 2 diabetes uncontrolled by pharmacotherapy.
Hypertension uncontrolled by pharmacotherapy.
Moderate to severe sleep apnea with a respiratory disturbance index (RDI) of 16 to 30 (moderate) or apnea-hypopnea index (AHI) >30 (severe) as documented through the completion of a laboratory based polysomnography.30 (For further information on sleep apnea, refer to the medical policy on Polysomnography for Evaluation of Sleep-Disordered Breathing.)
Good luck.
Michelle
Highest 242/Surgery 235/Goal 150/Lowest 158/Current 184 (Started working off regain and heading to goal 02/02/12.)
I don't have United Healthcare but my surgeon's office gave me the requirements for my insurance's 6 month medically supervised diet. They deal with insurance everyday, so they should have this insurance information.
My PCP (who I visited monthly while I was on weigh****chers) noted in her chart notes what I was eating and the exercise I was doing. The important thing is to document document and document whatever it is your insurance requires of you to show you met their requirements.
Good luck.
MM
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