NJ Direct hassles -6 months medically supervised nightmare

Hi,
I'm a new patient at South Jersey Bariatrics.  I asked my primary care physician to help me with by supervising  the 6 month  medically supervised weight loss program my insurance requires and she refused.  She said they have no program there.  So I asked the medical coordinator at South Jersey Bariatrics if they have a program if they have a weight loss program there and she said the person who coordinates that is out on sick leave.

I called NJ Direct and spoke with 4 different people who told me 4 different things about this requirement.  One person told me that if I go to Weigh****chers or work with a dietian I still have to have monthly visits with a doctor for the 6 months. 

I really don't know how to find a doctor who does this type of service.  I found a place called Center for Medical Weight Loss in my area but they also do bariatric surgery and I'd rather stay with the doctor I already chose.  Any one have to deal with NJ Direct about this? 

By the way, I went to a doctor recently for my knees and when we were discussing my weight he said "shame on you" when I told him I gained weight.  I've about had it with insurance companies and doctors at the moment.  I dread trying to find a weight loss doctor under these cir****tances.

Janice

Janice,

While I don't your insurance company's policy, and their official requirements, however going to your Primary care Physician monthly, while being on a "diet" should suffice. However I have heard that many insurance companies are making it more difficult, just so folks get dishearten and stop. I say, Ef them - and keep moving forward.

So join Weigh****chers, or Jenny Craig, or LA Loss or any of those, and make sure you see your Doctor EVERY MONTH !! This is important, because some insurance companies "reset" the clock if you miss 1 month. So my advice, make all your appoints the first week of the month, this way if you need to cancel, you have 3 - 4 weeks to make it up. Especially with summer coming up, and many Doctors going on vacation.

Hi,
   Thanks for your reply.  My primary care physician, who supports me in my WLS efforts, flat out refused to help me with the medically supervised plan.  She told me to get this help from SJB (the surgeons office) and they told me to get it from my PCP.

   I'm not giving up and going away but I have to say I am dreading another round of indignities from another doctor.  This week I saw an ortho who said "shame on you" to me about my weight.  So my feelings are a little bruised.  I don't even know how to find a doctorwho is sensitive to obesity as a medical issue and not a moral failing. SJB was unable to recommend someone, or so the bariatric coordinator said.

If any one knows of an enlightened doctor is Central Jersey who would offer me help and not judgement please let me know.

Thanks.

Sorry to hear about your PCP, and I find it strange but oh well ..

2 suggestions - call back your Insurance company, and see if attending a weight loss chain (WW, Jenny Craig, etc) would meet the 6 month requirement instead of going to a Doctors.  If they say no, ask them to clearly identify what is acceptable. Maybe a dietitian or nutritionists will meet the requirement.

If not, ask SJB if they know any PCP they can recommend. They usually can.

Final advice - when dealing with the insurance company, denote the time and get the person's name you are speaking to. Also, POLITELY tell the person who answers the phone you would like to speak to a supervisor because you've already gotten 5 different answers (even if you didn't). Again, denote time, name and what they say.

Every insurance company is different so check to get their exact requirements.  For example, my insurance company would not accept something like Weigh****chers as they specifically required "Medically supervised".

Once you know for sure, I would be back at my PCP's office.  First, make one appointment every month and TELL your doctor you want all your vital signs & weight taken at each appointment and that at the end of the six months, you will want copies of the records (they are your records so it should not be a problem).  In most cases, that is all insurance companies want - to see that you tried and attempted dieting.  During that time, WW or some other "diet" might help you lose enough to show you are serious.  I'm sure your PCP has some record of your weight over the time you have been with them and there is no reason they should not help you. 

If they still give you a hard time, the only alternative is to find another doctor but I wouldn't give up so easily.  Like Tom said, if they give you a hard time, they figure you will go away.  DON'T GO AWAY and call them enough and they will help you!

Good Luck!

You need to find another PCP, I've never heard of a doctor not willing to help his/her patient. My doctor gladly took down my weight for 6 months and recorded it as well as wrote a letter of medical necessity. Good luck.

I have NJ direct also - I went to my PCP originally in January 08 because my ankles and knees hurt - because of high blood pressure due to being so overweight.  My next visit was in February 08 for a follow up, and it was at that time I asked about the lapband - (had it, had it removed and now have RNY), and he made me come in each month for 6 months and follow the "diet".  More importantly, he weighed me every month.

I also visited with a nutritionist and my therapist, who also wrote letters for me that were submitted.  I think my surgeon's office now has both the NUT and PSYCH in house.

When the time came for my papers to be submitted to NJ Direct, they took my records and his letter of medical necessity without question, along with the rest of the paperwork my surgeon sent in for approval.  I was approved for the band the same day I was submitted.

Vicki and Tom have made excellent points too.

I had all 3 surgeries without issue, all paid for by NJ Direct.  

Not sure why your PCP is making things difficult for you.  NJ Direct has actually been amazing!

I also have NJ direct.  I told my pcp I needed to see her for a medically supervised program for 6 months and she said she didn't have such a program.  My surgeon's office said just go visit her once a month for 6 months and make sure she documents your height and weight and that you discussed weight loss options.  so I did.  when it came time for my pcp to write the letter of medical necessity, she refused.  I blew a gasket and pretty much forced her to, so she did.  NJ direct approved the surgery within a week's time.

The one thing I've learned from all of this is NEVER take NO for an answer.  Keep pushing.  Kick some ass and take some names (first and last)  LOL

Good Luck.

i have nj direct as well and i also am a patient with the south jersey bariatics...my pcp was not able to help me with the 6 month weight history and so they told me that all i had to was go to the support groups to get weighed and talk about the month prior..and the way i did not weight program..Yes that insurance company still wants a 6 month weight history...i know things will work out for you in due time...Keep your head up!

Thanks to everyone *****sponded.  I'm still discouraged but I will move forward. And thank you BigDanii.  I'll go to the next support group meeting and ask the doctors if that program is still available.  I spoke to June, the current bariatric coordinator, if the doctors office could help with the 6 months medically supervised diet and she told me no.  She said the person who used to coordinate that is out on sick leave.  (I think her name is Tina.)  I do find it hard to believe that the office would cancel that program and not replace the coordinator.  Maybe by the next meeting they will have someone new to help new patients who need it.  I just don't have the heart to try and find a new doctor who doesn't understand the reality of obesity.  I mentioned before that last week a doctor "shame on you" about my weight.   I was too ashamed to fight back and I needed his help.  Any way, thanks for your help.

Janice