6-Month Medically Supervised Diet?

Did your insurance require this?

Im worried because I was notified that this may be required by my Insurance (UHC). I called my Insurance  when I started this process back in April and they told me that WLS is covered 80% after my deductible and I asked if there was any specific requirements and they said it needs to be done at a Center of Excellence and thats it.  I was still not convinced, so I sent an email to the lady in charge of insurance approvals at my clinic letting her know what I was told and asking if there is anything else she can find out for me since I had no luck getting anything specific = She never replied, so I assumed I was okay to go (I should never assume). Well on Wednesday she spoke to me and told me that she never received my email! that sometimes her email doesnt work (laughing as if it was funny) . I told her I have it in my outbox and fowarded the message to her. She told me that usually insurances dont give any apefic requirements when you call them and that they most likely required the 6 month medically supervised diet. If I would've known this earlier, October would be my 6th month and I would for sure keep my tentative date.

If I have to do 6 months of this my date will definitely be pushed out  

Did you have to do this?? Should I try to get approval without this since my insurance did not mention it when I asked them for requirements??

I dont know what I should do.....

When I asked about requirements from my insurance company, they faxed me their requirements.  I'd ask for their requirements in writing.  Then there is no question.

Good luck.

 

i definitely agree with d.j. mine is also a requirement for the 6 month  supervised diet.
so just call your insurance and make sure you have to do this, you wouldnt want to waste time on something that wasnt even needed to be done.
good luck!

I called and asked about the requirements & was given the website to go to that lists them.  The lady sat on the phone with me & went over them one by one as I viewed them online.  I think a lot of insuranced require a 6 month medically supervised diet prior to surgery approval.  Mine also required a loss of 10 %.  I didn't qualify due to my BMI, though. 

Hang in there...Definitely call your insurance company & have them send you the paperwork regarding WLS coverage.

I have United Healthcare and the 6 months visit was apart of my specific plan I have with them.I would call UHC and ask the for the requirements it was given to me when I started my process in March and also given to my doctors office when they fax in for pre-determination.I was also asssigned a nurse with UHC that followed every step of the way for the six months.Call them and request the requirements but so your sure call them.

It's actually YOUR COMPANY who picks and chooses the requirements. UHC offers plans with no pre-surgery requirements (other than your BMI must meet NIH standards), 3 months supervised diet, or 6 months supervised diet - all at different price points to the company. Your company selects which option they want to include in their policy... or (as in the case of my company) none of the above - they can exclude coverage for all weight loss programs.

One of the things that annoys me hugely is that so often you can't get a copy of your company's FULL policy without asking for it. It's not online. It's not given to you when you sign up. It has to be mailed separately.

I am absolutely certain that all insurance companies have a standard policy of just trying to wear people down with delays and incidentals so we'll hopefully just go away....

I would agree with you about how difficult it is to get a copy of the policy and that they just try to wear you down. I asked for a copy of the policy and they directed me to it online..but in the comments, other than saying they cover WLS if morbidly obese (i'm only between BMI 35 and 39) it didn't say anything specific...it said "see morbid obesity policy". So i asked for the morbid obesity policy and was told that what i was reading from WAS the policy.  Well how can the policy say to "see the policy" as tho its something different?  There is something hidden there that no one is sharing. My papers are in, I should know in 2-3 weeks whether i'm approved and if i'm not, i guess i will have to start digging.   

UHC just issued a new Bariatric Surgery Medical Policy 10/1/09.  It was a pretty hefty revision - they now consider VSG proven and covered just like RNY, band, DS/BPD.  On the other hand they added some 'patient selection criteria' that was not in the old one - e.g. 6 months participation in a structured diet program, participation in a comprehensive WL program and psychological counseling.  These requirements are different/in addition to, the requirements from your company, if any.

When I started this journey back in March, VSG (which is what I am getting) wasn't covered, but I didn't need to belong to a diet program.  Now, my VSG is covered but I have to start a 6 month diet  program... ARGH, if only I didn't throw out just last year, my years and years of weigh****chers booklets. 

I have the new UHC policy as a .pdf - send me a private email and I'll forward a copy if you wish.

Luanne

I would love to see the policy.  I have UHC and nobody will give me a straight answer other then the 6 or  two 3 month doctor supervised diets and the BWI.  I am also curious as to if and when my doctor's office should do a pre-determination.
Email address is [email protected].

thanks,
Nichole