Question:
Do insurances require you to be on a diet first? My doc put me on a diet for this.

My doc actually sent me to a diabetic clinic (a new addition to my obesity problem, I'm now a newly diagnosed diabetic). Anyhoo, my doc said that insurances require you to be on a diet for the last 6 mos. It's been about 8 since my last of many diets. Is this true? Have any of you been able to get this surgery without having a more recent diet history?    — tinky471 (posted on March 5, 2003)

March 5, 2003
Actually, Aetna's new requirement is that you have been on a physician-supervised diet for 6 months out of the last 2 years and from what I have heard, the 6 months do not have to have been consecutive. Other insurances may have similar requirements...JR
   — John Rushton

March 5, 2003
Do you have physician supervised diets within the past 2 years? That is a key piece. However, him sending you for a diabetic nutrition consult is standard for anyone diagnosed with diabetes. You need to eat different as a diabetic. This physician supervised diet will only help your quest for WLS. You might be able to apply now, but because you are a newly diagnosed diabetic they are probably going to want to see if you can lose weight once you are on a proper diet and getting insulin etc. So they may ask for the 6 months anyway. I would probably give it 3-4 months and then submit for approval. They may come back and request the additional 2 months and may not. <p>My BCBS policy never told me the details of what they wanted in a detailed diet history but I provided one to them that went back to age 8. I actually tried very little fad diets or even structured diets like TOPS etc. I did WW for a few months as a teenager and that was it until 94/95 when I lost 200 lbs on 1200 calories and tons of exercise. After that I did Redux for 7 months, Xenical for 2 months and Wellbutrin SE for 7 months to try and help curb the appetite. The Redux was 1996-97, Xenical was 2001 and Wellbutrin was 2002. The advantage to me is that the last three things I tried were through a physician as they were medications that had to be prescribed. <p>I was not sure about putting down that I had lost the 200 lbs as I was afraid they'd come back and say well you can do it again. But I did put it on and all I know is I got my approval within 2 days after I faxed it. Although I also sent along a detailed medical history (surgeon only touched on 3 co-morbs and that is so little of my medical situaiton) with every diagnosed condition and every surgery (9) I have had since 1994. So they might have taken a look at that and said this woman needs help. Who knows.
   — zoedogcbr

March 5, 2003
It all depends. Not all insurance companies require that you submit a diet history or statements from a physician that they have been supervising your weight loss attempts. However, you will need to get the diabetes under control before your surgery, so that part is good. Do not let anyone tell you that the surgery will cure your diabetes. It won't. However, losing weight will enable you to control it via diet and exercise. The reason for getting it under good control is that high blood sugars can make healing difficult. Call your insurance company and ask them what their criteria are for approving the surgery. No matter what they tell you, tell them you want it in writing. Good luck.
   — garw

March 5, 2003
Many insruances are different. Many do require the 6month supervised diet. AETNA did for me, but they let it slide with a doctor's letter. Now I hear their standards are stricter. I also sent in 2 pages of diet attempts and failures, along with gym memberships, videos, anything I tried. I had about 30 different things and I'm only 23! Even if your insurance doesn't require a list, I think it helps. But as of when I sent in my insurance, I hadn't dieted in atleast over a year, maybe two. Sometimes you just get lucky, sometimes insurances need alot more info, esp. since there are more and more surgeries being performed, they don't want to pay for it as much. Goodluck to you- hope you get approved!
   — Lezlie Y.

March 5, 2003
Yes, some insurances can require proof of diet attempts before approving the surgery. I have Aetna and they no longer (as of 1/1/03) accept a Dr. letter. The dieting attempts must be in the medical records as well as dietician/nutritionist consultation, exercise program and "behavior modification" (I haven't figured that one out yet??). So yes, your doctor is doing you a favor by getting that started right away. It may take you a little longer than you had hoped, but this way at least you'll have the diabetes under control prior to the surgery. Good Luck
   — Carolyn M.