Supervised Diet Plan

Hello, everyone. I was scheduled for lap band surgery back in December of '07, but two weeks before surgery, I received a phone call from my surgeon's office telling me that my insurance, BCBS PPO, had denied my surgery. I was told that there was going to be an appeal. Needless to say, I was totally devastated, especially since I had gone to every single appointment imaginable, from having a sleep study done, to having a catherization performed at the hospital. I kept all of my appointments and did everything that was required of me. But...No one informed me about the six month supervised diet plan and that's where I hit a brick wall. If I would've known about this requirement, I would've been right on it, but no one informed me. I was so tired of the whole process I just gave up. I felt that all hope for me was lost, and I had no one to encourage me and prod me on. I haven't been on a scale for a long time, but I do know that I've gained more weight and I hate the way I feel and look. I hate taking pictures because what I see is not what I want to be. I decided to go back to the surgeon's office and inquire about the diet plan. Well, it turns out to be that my surgeon just started doing the supervised diet plan but my insurance won't pay for it. I told the lady that I didn't care paying for the visits. My first visit is for next Wednesday and I'm totally excited. She told me that the doctor just started doing this a couple of weeks ago and I think it's great. I believe that I have to pay $100 per visit, but I don't mind. I have scheduled appointments up to July, and by the looks of things, I might have my surgery in September. I asked her if I would have to go through the whole process of testing and all that, and she said no. My question is, what happens during these sessions? What does the doctor ask and what are you required to do or not do? How does this program work? If I would've started with the diet plan back in December, I would've been almost there. Six months do really go by very fast. I regret not doing it sooner, but it's never too late. Any insight will be appreciated. Thanks, Nereida

It depends on the doctor and the plan.  I just had to see my PCP once a month and he had to note my weight and that we spoke about diet.  Is this an insurance requirement or your surgeon's requirement?  It is not unusual for insurance companies to have the six month requirement. 

hi nereida you can do the supervised diet with your own PCP and only pay the co-pay -- it's just an appt once a month to get weighed and they go over your calorie intake and give you suggestions -- its' just a normal follow up appt with your own PCP and just make sure that your PCP writes you are there for obesity and nutrition -- it's simple -- don't pay more than you have too :)  good luck roberta

Nereida,

You may want to call the insurance company, and see if a “note” from your primary physician would be enough.

I had a similar issue with my insurance company, however my regular doctor contacted them and told them she has documented over the years of all my past diet plans, and she would send them any information they need so I didn’t have to do this. Not sure if she actually sent the forms in, but the insurance company reversed their decision, and I was able to have the operation without a supervised diet. Good luck !!

My PCP wrote a letter to the insurance company, but I was never on a supervised diet plan. The insurance company requires six months of a supervised diet plan. The office manager at the surgeon's office told me that my insurance had just started doing it.  When I was first denied, I did go to my PCP and told him I needed to be on a supervised diet plan and he told me he doesn't do that. It would've been cheaper for me to have it done through him because all I would have to pay would be the $10 copayment, but because he doesn't do that, I have to go through my surgeon and I have to cough up $100 every month which will put me out $600. I have a mild case of sleep apnea, high blood pressure, and asthma. I met all the requirements save for the supervised diet plan. Nereida

Perhaps your ins company could steer you toward someone in network who could do it.
Maybe your PCP could refer you to a nutritionist?

Before you go paying $100 a pop, look into alternatives. Since it's BCBS who's insisting you do this, they should be able to tell you if there's someone in network you can go to.
Also, a PPO is much more flexible than an HMO.

GL!!

Thanks, GL, I never thought of asking the insurance company to help me find a nutritionist who's in network. I don't even bother asking my PCP, he isn't much help. Nereida