Ins. requires 6 month diet

Hello everyone. I would like to have WLS in the very near future. I thought my insurance would not cover it at all, but found out today that my Cigna coverage will pay, but I have to have proof of a 6 month physician assisted diet. I have been dieting from 30 years! My docs advice has always been " eat less and exercise more", how profound! Anyway, now I must contact my PCP and ask him to help me on a 6 month documented diet. Has anyone been through this? I feel like it is a waste of time, and and I love my PCP for colds, broken bones, etc, I can't imagine going to his office every month to weigh in and discuss my diet. Thanks for your help. Kim

Kim. You came to the right place . There are several here that are going thru this now . Pat Birdsong and Kathy Hall are the names that come to mind right now for me . I am sure they will see this post and address it for you . From what I gather . You go once a month for 7 months .. not 6 . The first month is to do a pysical and to set your appointments and diet plans . The next 6 are basiclly weigh ins and overall check ins with them on how you are doing . I did not have to do this , so I will let them answer you as I know they will . It is not a waste of time, if you consider this a life saving surgery . I would have done anything they wanted . I would have walked a million miles for this surgery. And it is only another way for them to make your quit .. and I can tell you are not a quiter .. I will let those that have gone thru it answer you . But I sit here almost 200 lbs gone to tell you that if you want this bad enough .. you will do what they ask you to .. Stay positive and focused and you will get it . Much love and respect , Natalie

Hey Kim! I can help! I just went through this and got denied because incomplete info about my 6 month diet but then got approval after the complete info was submitted. Here is the info that I had to submit: Monthly weigh ins with the following info discussed: *weight *pounds lost for the week & total *number of calories per day (for example: 1000-1200 calories) *type/amount of exercise being done (for example: 30 mins walking 4-5 times/week) *diet medication being used & strength (for example: phentermine, meridia, etc) Hope that helps! Let me know if you need more info! Christine

Hi Kim...Nat is right, you came to the right place. I have been through it and finally got my surgery in December. Funny though, I got insurance approval right away...my surgeon made me lose the weight...just to show that I was committed...by the time I got the surgery, I felt like I needed to be "committed"....I stayed on a 1000 calorie diet for 7 months and walked almost everyday...only lost about 16 pounds....I worked so hard and couldn't lose...after the surgery "bam" 78 pounds gone forever...I feel great and my only problem is keeping up with clothes....I am undergrowing them..hehe. Good luck and it is worth all you have to go through. Hugs, Betsy

Hi, Kim! I too had to go through the supervised 6 month diet with my doctor. After the time was up, they STILL denied me, saying that my doc didn't have enough information in my records. Sooooooooo, I did it again, making sure that the doc documented EVERYTHING each month. Finally, after over a year, I was approved. I told my surgeon that the ins co. was waiting for me to either give up or die. However, it was sooo worth the wait and the jumping through hoops. My life is so much better now, at 128 pounds lighter! Best of luck to you! JoAnn

Thanks so much for your support! I am so glad I asked you guys for help! My insurance is Cigna HMO. The instructions say that the weight-loss program must include all of the following: (1) Dietary Therapy (ie low calorie diet) (2) Increased physical activity (exercise program) (3)Behavioral therapy to reinforce dietary therapy and increased activity (4) Consideration of pharmacotherapy with weight loss drugs I wish they would just give me a form to use for this, but I guess I will come up with my own with the help of my doc. He is a great guy, just not super organized. I am going to make sure the documentaion is done correctly. My concern is the Behavioral Therapy section. Should I arrange to see a therapist or psychiatrist? Did any of you have this requirement by your insurance? Thanks for your help. Kim

Hi Kim, Yes, you'll need to see a therapist, who will probably just do some testing or talk to you about your goals and what you hope to accomplish with the surgery. They need to find out if you have an eating disorder BEFORE surgery, so they can treat it and avoid a whole host of problems postop. Do you already have a surgeon picked out? If so, they have seen these insurance hoops many times and could help you with referrals (such as for the therapist). I didn't have this particular insurance but my sister had something similar, and although it took many months to get through the process, it was more than worth it in the end. Good luck, Carole

Hey Kim, I am the Kathy Hall that Tinkerbell (aka Natalie) told you about. I just finished my 6 months and it wasn't as bad as I thought. Of course that doesn't make the wait any easier. My insurance company is Highmark Blue Cross & Blue Sheild and that is one of their requirements. No fun, I must admit but at least while you're going through this, you feel that you are in control. I finished my medically supervised diet April 26 and my paperwork was submitted on April 27. It was denied. Then it was resubmitted as an appeal....thus denied again. Then resubmitted again and now is in review as a peer to peer review. Meaning my doctor has to meet with theirs (as in insurance co. doc) to come to a conclusion that I do need the surgery. My goodness......I am considered mobidly obese and I have a number of comobidies. What else do they need? It isn't as easy for some of us to get approved as it is for others. The only word of advise I can give you is don't expect anything until it happens because if you do you will drive your own self crazy. I speak from experience because when I started this journey almost a year ago, I was told that I would have an approval within 6 weeks. NOT!!!! Here it is 10 months later and I am still waiting. I wish you all the best and I will offer you whatever support I can. I am but an e mail away. Lots of Love Kathy