Documenting Excercise for HIghmark BCBS

I am new to the website and have really enjoyed reading the postings and learning from everyone's experiences.  I am just beginning to document for my insurance company and have a serious problem and question.   My insurance is through Highmark BCBS and have found a surgeon that is in-network.  I was thrilled about that part.  Of course, they have many qualifying things that I have to meet, but one bothers me.

I live in a VERY rural area- about 25 miles from the nearest gym or business with excercise equipment.  How can someone from a rural area document excercise?  I work and there is no way that I can travel that distance and back every day to a gym.  Has anyone else on this forum ever had or heard of anyone with the same problem?  How did they handle it?  Thanks for ANY help or suggestions.  I am very downhearted about this whole process already- just out the gate.

I have BCBS of Illinios, a PPO plan.  Check the Medical Policy for your particular plan to see what is outlined as a qualifying weight loss program.  My plan did not require gym memberships and I'm pretty sure yours doesn't either, only a doctor supervised weight loss program that included nutritional and behavioral therapy.  In plain English, that's a diet and lifestyle modifications such as increased physical activity.  Most morbidly obese people have a real difficulty with exercise due to health conditions and their weight bearing joints and/or pain or just downright inability because of size.  If you are mobile then just start with simple walking.  It's not distance but more duration and building stamina to progress your distance.  You need to work up to a minimum of 30 minutes per day.  Or, if you have a pool, pond or lake to swim in that's even easier on the joints.  You can keep your own activity logs.  It doesn't have to be anything fancy.  Handwritten is fine.  Simply log the date, the activity performed and duration of that activity.  Show it to your doctor and discuss it each month at your weigh in.  Get him/her to make notes of discussion & sign off on each month's sheet; or whoever he designates to oversee this can do this too.  Try to get in consistent exercise and show some progression if you are able to.  Record any limitations as well like if you get sick or suffer an injury.  My program had a certified exercise physiologist on staff who gave us pre-printed worksheets to fill in.  She checked them each month & discussed what we were doing and to see if we had any problems.  Basically it's just a mini diary of your daily activities and that includes housework & laundry.  Even keep a record of shopping trips or other outings in which you are physically active.  Seriously.  Put down when you went to the mall and were on your feet shopping for 2-1/2 hours and that kind of stuff.  ALL physical activity is exercise and burns calories.  Dancing to music, exercising to a workout video, etc.  My program's physiologist made notes on a separate paper along with the registered dietician and RN my surgeon had on his staff but it doesn't have to be that way if your doc's program is set up differently.  You just want to get as much documentation as possible that is verified by your doctor or surgeon (or his designated staff) so it shows EFFORT to the insurance company.  Good luck to you!

You must have a 6 month supervised diet and exercise and nutritional.  This all can be done per month by visiting your PCP, where he weighs you, talks to you about your exercise and work with you on nutrition like a 1500 or 1200 etc calorie diet and it has to be documented in his medical records and must be 6 consecutive months

see the medical policy for highmark

• The patient must participate in and meet the criteria of a structured nutrition and exercise program.  This includes dietitian/nutritionist consultation, low calorie diet, increased physical activity, behavioral modification, and/or pharmacologic therapy, documented in the medical record.  This structured nutrition and exercise program must meet all of the following criteria:

1. The nutrition and exercise program must be supervised and monitored by a physician working in cooperation with dieticians and/or nutritionists; and
2. The nutrition and exercise program(s) must be for a cumulative total of 6 months or longer in duration; and
3. The nutritional and exercise program must occur within two years prior to the surgery; and
4. The patient's participation in a structured nutrition and exercise program must be documented in the medical record by an attending physician who supervised the patient's progress.  A physician's summary letter is not sufficient documentation.  Documentation should include medical records of the physician's on-going assessments of the patient's progress throughout the course of the nutrition and exercise program.  For patients who participate in a structured nutrition and exercise program, medical records documenting the patient's participation and progress must be available for review.

Blue Cross has a new policy now...its 3 month of dieting.

FYI....not sure if you are aware of the change as of 7/1/09

Thanks when I looked it up there was no provider update stating that in the provider newsletter.  hmmmmmmmmmm I will have to check into that.  Thanks again

I have highmark bcbs as well and i called about the change and was told there was none so not all the bcbs changed . got it in writing just to be sure. that too is the same as the copy i asked for 6 months ago.

I, too, have Highmark BCBS.  Called last week and was told that it is still the 6-month cumulative diet followed by a physician.

I have one more visit with my doctor (9/16/09) then I will be ready to submit my documents for insurance approval.

Any tips/suggestions would be appreciated!!

Good Luck to Everyone!!!!!