Insurance ?

My insurance requires that I meet the following:

Member must meet either criterion 1 (physician-supervised nutrition and exercise program) or criterion 2 (multidisciplinary surgical preparatory regimen):

1. Physician-supervised nutrition and exercise program: Member has participated in physician-supervised nutrition and exercise program (including dietician consultation, low calorie diet, increased physical activity, and behavioral modification), documented in the medical record at each visit. This physician-supervised nutrition and exercise program must meet all of the following criteria:

   1. Nutrition and exercise program must be supervised and monitored by a physician working in cooperation with dieticians and/or nutritionists; and
   2. Nutrition and exercise program(s) must be for a cumulative total of 6 months or longer in duration and occur within 2 years prior to surgery, with participation in one program of at least three consecutive months. (Precertification may be made prior to completion of nutrition and exercise program as long as a cumulative of six months participation in nutrition and exercise program(s) will be completed prior to the date of surgery.); and

   3. Member's participation in a physician-supervised nutrition and exercise program must be documented in the medical record by an attending physician who supervised the member's participation. The nutrition and exercise program may be administered as part of the surgical preparative regimen, and participation in the nutrition and exercise program may be supervised by the surgeon who will perform the surgery or by some other physician. Note: A physician's summary letter is not sufficient documentation. Documentation should include medical records of physician's contemporaneous assessment of patient's progress throughout the course of the nutrition and exercise program. For members who participate in a physician-administered nutrition and exercise program (e.g., MediFast, OptiFast), program records documenting the member's participation and progress may substitute for physician medical records;

   or

2. Multidisciplinary surgical preparatory regimen: Proximate to the time of surgery, member must participate in organized multidisciplinary surgical preparatory regimen of at least three months duration meeting all of the following criteria, in order to improve surgical outcomes, reduce the potential for surgical complications, and establish the member's ability to comply with post-operative medical care and dietary restrictions:

   1. Consultation with a dietician or nutritionist; and
   2. Reduced-calorie diet program supervised by dietician or nutritionist; and
   3. Exercise regimen (unless contraindicated) to improve pulmonary reserve prior to surgery, supervised by exercise therapist or other qualified professional; and
   4. Behavior modification program supervised by qualified professional; and

   5. Documentation in the medical record of the member's participation in the multidisciplinary surgical preparatory regimen at each visit. (A physician's summary letter, without evidence of contemporaneous oversight, is not sufficient documentation. Documentation should include medical records of the physician's initial assessment of the member, and the physician's assessment of the member's progress at the completion of the multidisciplinary surgical preparatory regimen.)
      
      
      
      HELP.....any advice to get around this??????????

The only way I know around it is to be a self pay, and you only have to jump thru whatever your particular surgeon has. 

Did you mean to put this on the Mexico forum, girlie?  I think you might get more help on the insurance forum!

(or maybe not, but what do I know!?)

Hope you get help soon.

Yeah, I agree, there's ZERO way of getting around it unless you want to be a self-pay patient.  Some people didn't have medical records documenting even weight over the past 2 years & had to wait that long while jumping through all of the ins-required hoops to get their surgery approved.  Mexico & Brazil (Marchesini is good) are the cheapest self-pay options.

P.S.  Have you ever heard of the duodenal switch?  It's a fantastic surgery with better 5-10 year outcomes - more weight loss & less regain.  Most people haven't even heard of it, so I'm just trying to spread the news!  There's a duodenal switch forum.  It's been around for 20 years & is NOT experimental.