i'm new to obh and need help

i called medicare today to find out what their critera I have to meet to get bariatric surgery. I meet all of them except... previous unsucessful medically supervised diet. I told him I was on a very strict diet for y diabetes and if that was enough, or what kind of documentation they needed and I really couldn't get a straight answer. It left me really confused. What exactly qualify as a medically superivised diet? Does any one know? What are they looking for? And what happens if I start to lose weight on their diet? Can they deny me for that?  OMG please help! Or does anyone know of anywhere I can go for a medically supervised diet that accepts medicare and medicaid?

Hi Kimmy I am on my second month of a medically supervised diet. Basically what it is going to the Dr once a months to get weighed in and he has to establish a diet for you including recommended exercising time... e.g 1200 calorie diet and 30 minutes 3x a week. I spoke with the nurse at my insurance company regarding the medically supervised diet and she voluntarily told me they ar e not looking to see if you lost or gained weight on the supervised diet but rather could follow the plan set forth by your Dr. They are more concerned with you being able to follow the diet because the RNY is a surgery that will require you to follow a plan...

thank you so much for replying. i spoke to me pcp's nurse and she said that they don't do nutrician or diet planning. no one around here really does ( that takes my insurance anyway.) there is one, but i have to wait like 6 months to get an appointment with her. that is what happened when I was first diagnosed with diabetes then the day of my appointment they told me it was cancelled. anyway i'm feeling a little defeated. I've been following my diet, but haven't been excersing, and i've gained over 40 lbs!!! i'm not even sure if that is right cause the scale at my endocronologist doesn't go over 360 and i was 341 a month ago and damn near broke the scale this time. I really just don't know what to do.    anywho.... sorry about the break down, but thank you for the support.

hi dont be defeated keep at this if you want the surgery. call your local hospital and see if they can point you to a doctor sometimes the medical society can help too. i would also post this message on the main board here as it reaches a wider audience and maybe someone has experience with medicare. basically you need to find a new primary care doctor that is willing to help you thru this also. its amazing how that makes a difference if the doctor is on your side. good luck, jacki

My husbands plan accepted 6 months of Weigh****chers weigh in as supervised diet. You can always ask if that's acceptable. -Janine

hi,  set up an appt and talk with your doc.  he does not have to be a nutrition specialist of any kind.  all you have to do is go once a month, and have him record your weight.  also have him record that you were told to exercise and eat 1200 calories a day.  that's it.  same old boring thing for 6 mos.  i did not lose during this period, personally.  so long as your bmi does not go under 40 (35 if you have comorbidities) during the diet, it's ok that you lose.

HI, I've been working at this for 4 years now and have finally gotten it right ! I needed a Psychiatric  evaluation, nutrionist evaluation, cardiac evaluation, diabetes evaluation and at least 6 months on a Dr. supervised diet.  All that meant was that I say my family Dr. once a month for at least 6 months.  He weighed me and suggested different exercising and diet methods.  He kept a written account of it.  This plus all the others evaluations went to my surgeon and his office sent it in to insurance. Finally !!! It was that supervised diet that finally got it done.  Good Luck.

thanks to everyone *****plies to my post. well it looks like i'm gonna have to give in and put out the money for the diet. i'm actually goiong to go through the surgeon i originally consulted with because he just started a weight loss (non surgical) program, but medicare will not cover it. 100 dollars it is going to cost me not including meds, supplements, and meal replacements. im pretty broke too, but im sure God will make it work. my pcp can't help. not sure if it is can't or won't. oh well. im gonna do this. im desparate and determined - im sure one of those will push me through. my other issue now is that medicare specifically said previously UNSUCCESSFUL attempts to lose weight (documented) here is my delema.  if im successful they (medicare) won't cover the surgery. if im unsuccessful (which is easy  to do) he- the surgeon- won't do the surgery!!!!!! what to do! IM SO CONFUZZED its not even funny.

Generally speaking if while on a diet your BMI does not fall below 35, than according to health standards, that is UNSUCCESSFUL.  You can still lose weight and be "morbidly obese" or "Obese with comorbidities" and qualify for the surgery.  I've seen people lose weight on their 6 mos supervised diet and be approved with no problems.  The other thing is that after a diet is completed, if you gain the weight back, that is also considered a failed diet.  You should be ok - go ahead and lose some weight - doubtful that will hold you back from your surgery. Pam

Kimmy, I see you're in Somers Point. I live in Pleasantville and my surgeon is Dr. Onopchenko. He just recently started the supervised diet plan and I had my first appointment this past Wednesday. After going through a series of tests and appointments, I finally had a date for my lap band surgery. Two weeks before the surgery, the carpet was pulled from under my feet when they asked for 6 months of supervised diet plan. I met all the requirements. My BMI was 39 with comorbidities: high blood pressure, cholesterol slightly high, mild sleep apnea, and asthma. When the papers were submitted for approval, my insurance threw me a left curve. I was so depressed and frustrated I just gave up. But now I'm back on track. I was told that it was going to be $100 per visit, but I was pleasantly surprised to know that I only had to pay $10 copay. I asked the nurse practicioner the same thing you're concerned about. I asked her if I lose the weight will the insurance still pay for the surgery. She told me that the insurance company just wants to see that I'm trying and not really looking at how much weight I lose or not lose. As long as I don't gain any weight during the six months, I'm fine. If my BMI falls below 35, then they will not pay for the surgery, but because I have comorbidities it's safe for me to lose some weight and still be approved. Nereida