Question:
proof of diets

How do you show proof of diets you have been on to the insurance company and the hospital? I have dieted where you cut back on calories and excersise but have never really tried any of the commercial diets because of costs and knew that I would gain the weight after I stopped them anyway. My pcp knows that I have attempted numerous times to lose weight and have a hard time because of the meds I am on for bi-polar. I do show in my charts that I have lost and gained, will this count as diet attempts?    — LindaD. (posted on March 28, 2008)

March 28, 2008
your file with your pcp or a dietician were the ones that my insurance company was looking for as proof. However you need to ask this question to your insurance company since they are all different and you have to meet their specific guidelines. My insurance company changed their guidelines part way through my 6 -month documented weight loss program and decided I didn't need to comply with this....a very fortunate for me decision however they can be real difficult too. So find out what is specific to your insurance and good luck.
   — cjjordan

March 28, 2008
Insurance companies vary in what requirements they want met before they pay for WLS. I met the co morbid conditions because my BMI was under 40, at 39.5. They also required document proof of a medically supervised diet partipation of at least 6 months duration within the past 5 years. I had surgery in May, 2006, and I'd participated in a program of 8 months duration in 2002. I approached the manager of the program of 2002, and had her draft a letter acknowledging my particpation in their program. This got me out of a specific diet regimine program, but I still had to partipate in a nutrition educations and RNY information class several weeks in duration. My classes were 8 weeks long, but were changed to 22 weeks for those who entered the next nutrition class. You need documented proof, and you may still need to particpate in another program within your insurance company. Most insurance companies just don't authorize a 30K surgery at a moments notice.
   — Dave Chambers

March 28, 2008
What they will want to see is a record from your PCP where you had your weight and BP checked and when there at least every 3-6 months, and notes from the doctor's file that you were trying to diet without much success. The PCP in a HMO is the guy that can get you in to a WLS program or keep you out. If you have to start over because the PCP will not cooperate, start with a new PCP and make sure he or she knows why you came to them. Then after 6 months the insurace company will review his records.
   — William (Bill) wmil

March 29, 2008
I was suprised to find out that Weight watchers and nutrasystems Did not qualify as weight loss programs under their guidelines. They wanted my doctor and a registered nutritionist...which i did not do. My medical charts over the years have showed my ups and downs so we are hoping that is enough.
   — [Deactivated Member]

April 1, 2008
YES. THIS WILL HELP EXPEDITE MATTERS FASTER. THEY HAVE TO TAKE THIS INCASIDERATION, THIS SHOWS THAT YOU HAVE ATTEMPT FOR A WHILE TO LOOSE WIEHGT WITH THE HELP OF OTHER . IF THIS HELP HAS STILL FAILED YOU THE LAST RESORT IS WLS, WHICH THEY CANT DENY YOU IF SO FILE THE APEAL, AND A COMPLAINT BECAUSE THEY CANT DENY YOU IF YOUR DR, RECCOMEND IT MEDICALY NECCESARY. AS FOR MY SELF. WHEN I FIRST WALK INTO MY DR. OFFICE FOR THE CONSULTATION I HAD BROUGHT WITH ME 6 YRS OF ME GOING BACK IN FOR TO WIGHT WATCHER, JENNY CRAIG, NUTRA SYSTEM, LA WEIGHT LOSS, AND A WEIGHT LOSS DR. ALONG WITH 10 OF BEING ACTIVE AT THE GYM. I CAME PREPARED THAT DAY AND I WALD OUT THE DR. OFFCE WITH A 2 MONTH SCEDUAL DATE FOR SURGERY THAT SAME DAY. OF WHICH MY INSURANCE COULDNT DENY ME BECAUSE EVERYTHING THE WOULD RECCOMEND ME TO DOE WAS DONE IN THE PAST ASWELL AS THE CURRENT. I WAS APROVE IMMEDIATLY
   — yvettetas