Physician-Supervised weight loss program

Libby B.
on 4/16/10 7:20 am - Des Moines, IA
I finally got this stupid packet from the insurance company that states that I "have to complete a physician-supervised weight loss program within two years of surgery"

Did anyone else have to do this and what satisfies this requirement? 

I would like to point out that it states nothing about this in my insurance policy regarding WLS...

I have United HealthCare if that helps.    I might check with the folks on the ins board and see if they have any insight. 


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jazzybella
on 4/16/10 10:08 am - Canton, MI
I know that some insurance companies require that you complete a  physican-supervised weight loss program before you can be approved for WLS. They usually require that you stay on those programs for 3 - 6 months before you can be approved for the WLS although there is an OH member who has to complete a 12 month supervised diet before she can be approved; but I think that is extremely rare.

Sometimes an insurance company may accept a supervised program such as Weigh****chers while other insurance companies will only accept a program done through a doctor. You will have to call the insurance comany to find out. If you do have to complete a program you may be able to complete that program with the weight loss clinic you are working with. I am working with a surgeon at Barix and I believe that they have dieticans there who would supervise a weight loss program for me if my insurance company required it. 
    
                              Don't let perfect be the enemy of good   
Libby B.
on 4/16/10 10:37 am - Des Moines, IA
I think I will be OK because after doing some more digging it appears that the diet only applies to certain plans.  It seems that the UHC Choice plans don't include the diet.  I think that all of their printed information automatically includes it.   I was starting to freak out a little.


Libby- 27  Visit my blog!
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exohexoh
on 4/16/10 11:28 am - West Chester, PA
 i have uhc choice and it does require it for me. it depends on your employer/group the insurance is through. from what i have gathered they kind of pick and choose what "package" they want. i had to do a 6 month supervised diet. i used my pcp for it, and it basically consisted of me going in once a month and getting weighed. i'm sure a lot of drs are a lot more strict, but my dr knows me really well and knows i'm serious about this (which is usually why the diet is required, to pull out people who decide to have surgery spur of the moment, and to show they have commitment, blah blah blah). 

a lot of surgeon groups require it too. the first surgeon i planned on using required a 3 month diet through his nutritionist, or more depending on insurance. but he wasn't at a center of excellence, which is another biggie with uhc. the third requirement i had was that i had a psych eval which i'm pretty sure is standard for most if not all insurance policies/surgeons.

then your surgeon will probably have required things for you to do. i needed cardiology clearance (i have a heart condition, but most require this anyway), and upper gi (had one done last year i can use), sleep studies and consult with a sleep dr (consult is monday), a giant list of blood work, a chest x-ray, and a pulmonary function test. the last 3 i haven't done yet. but i'll prob do the blood work and x-ray while i'm at the hospital for the dr on monday. then after i'm approved and scheduled i have to go to a nutrition class at the surgeon's office.

i was like you and thought it was ridiculous to have to do all this stuff before surgery, but the further along in the process i get, the more i understand. they want everything to go as smoothly as possible, and to make sure that you are in this for the long haul. i started this process in october and i'm probably not having surgery until july, so it's definitely a long journey. but really it's just the beginning :-)





                                                                       <3 jen <3

               

                                    <3 starting weight: 252 <3 goal weight: 135 <3 current weight: 151 <3

                                      RNY: 9/27/10 <3 Extended Tummy Tuck w/hip & thigh lipo: 6/6/13

Libby B.
on 4/16/10 12:30 pm - Des Moines, IA

Thanks Jen- 

       I am curious as to where you work but I will PM you!  

My sleep study stuff is done I was diagnosed with severe sleep apnea last August and have been loving my cpap ever since.  I just have a follow up on Monday where they will take a download from my cpap. 

I am not so worried about all the pre-surgery testing I just wi**** would go more quickly....  The center of excellence thing isn't an issue here because 2 of our 3 hospitals in Des Moines qualify and the hospital in Iowa City is as well.  
I'm lucky my mom had RNY 4 years ago so I get lots of advice from her  since I am using the same surgeon.  She just isn't as dramatic as I am about the small things!   

I just thought the 6 mth diet seemed stupid  if it were easy for me to lose weight I would have done it by now. 



Libby- 27  Visit my blog!
http://beentherewasthat.blogspot.com/
    
exohexoh
on 4/16/10 1:53 pm - West Chester, PA
 i've had a cpap for 3 years and have used it maybe 20 times? i just cannot sleep with that damn thing on. i wore one for my sleep study a few weeks ago for the first time in at least 2 years and had a panic attack with it on lol. 

surprisingly only one of the hospitals in philly (upenn) is a coe. its kind of ridiculous. i  still like that first dr i went to better and his program seemed more hands on, but upenn is one of the top 10 hospitals in the country so i know i'll be in good hands. 

                                                                       <3 jen <3

               

                                    <3 starting weight: 252 <3 goal weight: 135 <3 current weight: 151 <3

                                      RNY: 9/27/10 <3 Extended Tummy Tuck w/hip & thigh lipo: 6/6/13

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