Insurance Help?!

I had my first meeting with the surgeon yesterday. The ladies is his office say that I need six months supervised diet history, HOWEVER, my insurance policy just states that I need to show that I have been obese for four out of the last five years. Could this be a requirement that his office has in addition to the info needed by the insurance company?  I am really confused.  This wouldn't be such a problem, if dealing with my PCP had not been a nightmare thus far. He isn't WLS friendly.

This is most likely an insurance requirement. My insurance company did require that I be able to show that I was obese for more then five years, had a BMI of over 40% and my comoridities.

I agree with Paul.  Most requirements for supervised diets generally come from insurance and not a surgeon.  Although some surgeons do "RECOMMEND" you lose weight, I've never really heard of one requiring you to do that.  As for his advice of finding a more supportive PCP, that probably isnt a bad idea at all.  Things will definitely go smoother if you can get a PCP who supports you.  I am actually on my last month for my supervised diet required by my insurance.  Mine is a 6-month required diet as well.  My last weigh-in is Monday, April 21st!  In all honesty, I was like this sux when I learned I had to do this but it was real good for me to do.  It gave me time to prepare and to be able to learn that I'm going to have to alter my eating methods and step up the excercise if I want to be successful at this.  I've lost 27lbs so far on this required diet which not only helped me physically but mentally as well.  So if you do end up having to do it just remember things will go by fast and really take advantage of the time!  Good luck with everything!

 

 

Tonya

I had to have a letter showing my weight history for the past five years, and I had other requirements such as a BMI great than 40 or a couple of comorbidities, etc.  I did NOT have to have a 6 month supervised diet.  I know some ins co. do require that.  I would call your ins. co and ask if they require it before actually spending 6 months doing something you don't have to do. Stephanie

First, ask your surgeon why the 6 month MSD. Did their insurance coordinator call your insurer? When I call for patients, I can see why they get confused. I have to talk to ususally 5 people to get the full requirements.  The customer service person will tell you things like: your BMI must be >40, over age 18, etc, but usually does not have computer access to the full requirements, like exactly what is required for a MSD and psych testing, etc. I end up speaking with utilization management, pre-certifications or pre-determinations (each insurer calls it something different) in order to get the full scoop. Your surgeon might be very familiar with your insurance requirements already. I can look at many patients' insurance cards now and know the requirements, for example: Brinks Home security policy with United Health Care does not require the MSD, but the State employees who have UHC do. So start there, call the insurance person at your surgeon. I work for a bariatric surgoen now in Tennessee (nurse) and belong to 2 bariatric programs in New England--none of the three require a 6month diet, only if the insurance does. Good luck! Bonnie

Thank you so much for your help. That is a great idea. I have BCBS of North Carolina, which isn't very common in this area, so I think people automatically think that it is Mountain State Blue Cross Blue Shield, which is different (I think)   Thank you again for your help! And I will try your suggestion first thing tomorrow morning!

Boy I wish I was at work right now! This is the second time tonight I need my insurance reqs! I do not think BCBS NC needs a 6 month MSD, you do need extra testing like and EGD, Chest x-ray, etc. and nutritionist consult. When I get to work tomorrow, I will pull up the reqs and see if I can email them to you. Send me a PM with your email address and I will see what I can do. I am working in Knoxville, Tennessee now for a bariatric surgeon (this Yankee refuses to change her town on the avatar!) and have gotten 3 approved with BCBS of NC. When you have the reqs, you can show your surgeon what you need. Bonnie

I sent a PM to you!  Thanks so much!