Question:
Specific medically supervised diet that must be in your records to qualify for WLS?

I have Humana Premier HMO and the Advocate Beverly Center in Chicago. This is where my pcp is located. I called Humana to find out what criteria had to be met to be eligible for WLS and I was told that I had to be 100 or more pounds overweight with a BMI of 40 or more and that I needed my pcp's authorization. I also asked what other info I needed such as diet history, etc so I could get a general idea and I was told that the doctor would refer me to referral organization specialist who would detail what other info I needed. I am curious as to if there is a 6 month or 12 month medically supervised diet that a patient needs before they can have WLS and what else is needed? I am 100 lbs overweight and just at the 40 BMI mark, my doctor previously didn't really ask about my diet over the years. He just asked about my eating habits and excercise vaguely. I would reply that I have cut back on junk and I am walking on my lunch hour at work or something like that. I did send a letter deatailing all the different weight loss programs I tried like WW which I only went to for a 1 or 2 mos, and that I tried dozens of over the counter weight loss programs and dozens of diets, but nothing really medically supervised. Do you think they will make me wait another 12 months and make me go through a medically supervised diet???? Has anyone with Humana Premiere been told they didn't have a medically supervised diet in their medical charts and would have to wait 6-12 months? If so how long did they supervise the diet? What else did they look for? Thanks in Advance for Your Responses!!!    — ToriJ (posted on June 16, 2003)

June 16, 2003
I'm in New Jersey, so I don't have your health insurance. However, my insurance company requested clinical records of medically supervised weight loss programs. My programs included Optifast, and prescriptions for most of the latest weight loss drugs, such as Phen-fen, Meridia, and Xenical. If you don't have clincal (medical records) documentation, or if you have never used any of the prescription weight loss medications, then chances are that you will need to develop clinical records prior to gaining approval for surgery. But, you should see what your PCP may be able to document for you in a letter of medical necessity.
   — David F.