Nutrionist visits for revision

tdslf1
on 1/17/16 8:52 am - Joliet, IL

I am in the process of trying to get a revision from lap band to bypass which is what I wanted to get in the first place but didn't. According to the surgeon I have, I need to take 6 nutrition classes and if I go through his office, they are scheduled every two weeks. So according to their schedule the first class starts Jan 20 then every two weeks. I wont finish until April. I have to see the same nutritionist even though they have 3 on staff which means I cant get that requirement over quicker. Here is my question. My insurance company said this about nutrition when a member is going for any bariatric surgery. This is BCBS of ILL :

 

??Documentation?from?the?surgeon?attesting?that?the?patient?has?been educated?in?and?understands?the?post?operative?regimen,?which?should include?ALL?of?the?following?components:   1.?Nutrition?program,?which?may?include?a?very?low?calorie?diet?or?a recognized commercial?diet?based?weight?loss?program??AND 2.?Behavior?modification?or?behavioral?health?interventions??AND 3.?Counseling?and?instruction?on?exercise?and?increased?physical activity??AND 4.?Ongoing?support?for?lifestyle?changes?to?make?and?maintain appropriate?choices?that?will?reduce?health?risk?factors?and?improve overall?health??AND   This does not give a time frame of 6 visits. Why do I have to have that many for a revision? And if I do have to have 6 can I go to a nutritionist of my own choosing who can clear me in less than 3 months...?
Renny    
White Dove
on 1/17/16 11:36 am, edited 1/17/16 4:05 am - Warren, OH

Documentation from the surgeon attesting that the patient has been educated in and understands the post-operative regimen, which should include ALL of the following components:
1 Nutrition program, which may include a very low calorie diet or a recognized commercial diet-based weight loss program AND
2 Behavior modification or behavioral health interventions AND
3 Counseling and instruction on exercise and increased physical activity AND
4 Ongoing support for lifestyle changes to make and maintain appropriate choices that will reduce health risk factors and improve overall health AND

Your insurance does not have a six visit timeframe.  Your surgeon may not agree to tell the insurance company that he is comfortable with your education from another program.

Real life begins where your comfort zone ends

tdslf1
on 1/17/16 1:02 pm - Joliet, IL

My next question is...What should my argument be to shorten that time frame from 6 visits to 3 seeing as how my insurance doesn't give a time frame and does not say when this education had to have taken place? Why can I not use the education I used from my lap band? I had the lap band nutritional visits within the same hospital as I am trying to have the revision now......Also can I go to my own nutritionist and satisfy this component if the current doctor requires 6 visits...? 

Renny    
Grim_Traveller
on 1/17/16 1:57 pm
RNY on 08/21/12

The insurance company has certain requirements. If you don't meet those, they won't cover the surgery.

Surgeons may or may not have requirements IN ADDITION to what the insurance cpmpany wants. It looks like your surgeon has those extra requirements. If you aren't happy with that, you can look around for a surgeon with fewer prerequisites. But the surgeon has every right to set their own rules.

For instance, many surgeons will not operate if you are a smoker. They will do a nicotine test, and if you fail, they will not operate. I have never seen an insurance company with that requirement, but many, if not mosy, surgeons do.

So, either follow their rules, or find a new doctor.

6'3" tall, male.

Highest weight was 475. RNY on 08/21/12. Current weight: 198.

M1 -24; M2 -21; M3 -19; M4 -21; M5 -13; M6 -21; M7 -10; M8 -16; M9 -10; M10 -8; M11 -6; M12 -5.

Baby1234
on 1/17/16 2:20 pm

They are very tough for revisions.I had to jump through hoops...my band flipped so they deemed it a necessary surgery.

tdslf1
on 1/18/16 6:51 pm - Joliet, IL

Spoke with the coordinator today. She said she submitted to my insurance to take the band out. Then when I have satisfied the nutritionist portion(which is all I have left) she will submit for a regular gastric by. There will be no mention of revision, just 2 separate issues to address by the insurance company. Has anyone had success like this....?

Renny    
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