Question:
What are insurance companies looking for with the 6 month med. supervised diet?

I am currently trying to get approved by Aetna for RNY. I've completed everything they've asked for and am now doing the 6 month medically supervised diet with my doctor. What are they looking for?    — [Deactivated Member] (posted on January 28, 2006)

January 28, 2006
I two have just completed the 6month regimented diet, but i also tossed in a behavior modification therapist, and exercise tharapist both supervised by the surgeon, as the option OR specified CLINICAL POLICY BULITIN 0157,YOU need to read and know it, it available on the member navigator page,http://www.aetna.com/cpb/data/CPBA0157.html shit, this is a new one and I havent read this one, , any way, the big OR is only 3 months and they substitute for the 6month diet, the deal is that you are compliant to the rigors of the after life that you are about to commit too, the rules are rigorus,the potential for self harm are real, this is not to be taken likely, this is their only opportunity to screen sincere patients from the casual "wannabees, You do not have to be successful in the diet, but be compliant.
   — walter A.

January 28, 2006
My insurance also asked for the 6 month Dr. supervised diet. You need to go to your Dr. at least once a month and be weighed. While there, your Dr. must discuss with you the importance of calorie counting and excercise-she/he must take notes of each meeting-you do not have to lose weight-at least I didn't. Then your Dr. must write a letter of support for your surgery and include all the notes from your 6 months. Do NOT skip a month-or you will be starting over-however, once I jumped through all the hoops-it only took my insurance one day to approve.
   — janh

January 28, 2006
I had to have documented 6 months weigh-in..my weight fluctuated move the 6 months, going up and down....also had a blood pressure taken...discussed activites and foods eaten....doctor makes notes of visit, and it is sent into the surgeon who sends it off through a pre-approval department...I was turned down first time because my dr sent in request too soon, but appeal was done after 6th visit and I was approved. started in march of 05, was approved sept 05, and surgery was nov 05. BTW this was going through CIGNA OAP FIRST CHOICE
   — puppymutts

January 29, 2006
Usually the insurance companies are looking for your ability to follow up. WLS include consistent follow up. If a person continuously cancels or reschedules their appointments during their 6 month supervised diet, then the medical director at the ins co wonders if this person will have the same behavior after surgery.
   — NurseTC

January 29, 2006
Their also looking for documented evidence that you've tried a diet under a physician's care and the results. I did Atkins for 6 months and went to my pcp every month and weighed in.
   — jforten

January 29, 2006
Mine wanted me to on a dietary program which could be anything, I chose Weight Watchers and monthly clinical encounters with a healthcare professional who does not perform the surgery - went to my PCP. There are several theories on why they want you to do this. 1) They want you to attempt to lose weight and maybe just maybe you will do great and not need the sugery. 2) They are hoping that you will change insurance before you get the 6 months in so they won't have to pay for it (most likely). 3) They just like to torture fat people!! :-) Good luck!
   — classite

January 30, 2006
They want to know that you can stick to a diet, and also that you have exhausted conventional ways to lose weight.
   — Novashannon