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Post by nacartwright on Jan 30, 2012 17:42:19 GMT -5
All,
My insurance requires a 6 month medically supervised diet...which I have been on the road for the entire month of January and finally will be home for a few weeks to start this.
My question is I've been having a couple health issues - couple that are not serious but are possibly related to my weight...The bariatric center/surgeons office advised that when we make the appointment to make it as specific as possible that you are there for weight loss or diet or what ever...they said some insurance companies see it listed with other things or as a secondary reason they will not count it....
has anyone else experienced this? Should I make two appointments with my internist? One for "normal doctor stuff" and another for the medically supervised diet?
My doctor essentially said he supports my decision 100% and he'll do whatever I need him to do - but I was curious if anyone else has heard such a thing regarding making appointments?
The other option is seeing the bariatric centers bariatitian (SP)...
Which would be best? Internist or the bariatric center (St. Vincent)?
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Post by brybry76 on Jan 30, 2012 18:26:25 GMT -5
As long as your weight-related issues are listed as conditions observed by your doctor, you should be fine. The longer you've been with your doctor the better... I was assured approval based solely on my BMI even though I didn't have any co-morbidities. I'm sure you will have to do the sleep study and an endoscopy. Even things like acid reflux can help your case. If you are really worried, ask your doctor's staff to call your surgeon's staff so they can coordinate. Good luck! I started my process this time last year... I didn't lose very much weight before surgery either, so don't freak out!
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Post by ricky136 on Jan 30, 2012 18:28:45 GMT -5
I would say after the PCP has asked you all of the WLS questions, exercise, diet, Etc. Then at the end of that ask him about your other issues. My PCP submits a report to my surgeon after each monthly visit about the supervised portion only. I wouldn't worry about a second appointment.
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Post by ricky136 on Jan 30, 2012 18:31:03 GMT -5
And what Bryan said.
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Post by shann_ds on Jan 30, 2012 18:52:04 GMT -5
My surgeon had a form that my pcp filled out each month that I went. Ask if there's some sort of accepted report.
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Post by meredith123 on Jan 30, 2012 20:23:55 GMT -5
I went to a bariatric center for my 6 month weight loss program. That way I knew that everything got doocumented the way the insurance requires it. Also the place I went worked with the surgeon's office I was going to use before I found out about the DS and switched surgeons. I guess it didn't even occur to me that I could have just went to my PCP for the 6 months diet. The bariatric center was nice though, I saw the doctor every month, plus they had me meeting with a nutritionist every month and a excercise person every other month.
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Post by reinventingangela on Jan 30, 2012 22:22:08 GMT -5
Thanks for posting this question, this is exactly what I also needed to ask today! Im going to contact the surgeon I think Im going to use and see if they have a form because my PCP pretty much told me he's clueless...
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Post by calendargirl on Jan 30, 2012 23:19:43 GMT -5
My insurance company sent me a form to have the doctor sign every month. It was simple: Date, Weight, Provider Name, Provider Signature, Check if you talked about (1) Diet (2) Exercise (3) Behavior Modification. That's it.
However, because I had such an extensive dieting history, I wrote a letter asking them to waive the 6-month requirement. They asked for additional proof, which I sent. Within a week they let me know they would NOT require a 6-month diet.
Just a thought, in case you've had some type of monitored weight loss program that lasted more than 6-months already....
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Post by sheanie on Jan 31, 2012 9:45:13 GMT -5
Get a copy of your PCP's records of your visits. Look for any mention of your weight problem. Use that as a starting point for the 6 month diet requirement.
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Post by terilynne on Jan 31, 2012 10:53:37 GMT -5
Mine (Optimum Choice at the time) was based on 6 months worth of weight watchers that I had done about 6 months before. Glad I kept that little book they give you. That's all I needed to send them.
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Post by ricky136 on Jan 31, 2012 11:09:32 GMT -5
I am in month 2 and keeping detailed documentation of everything. Its not that i don't trust my PCP, I just don't want any issues.
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Post by jillybean720 on Jan 31, 2012 16:04:10 GMT -5
The answer is: it depends on your insurance. I went and ONLY discussed my weight/diet at the diet appointments. Some insurance companies WILL not count it if the reason for your appointment includes anything other than the weight/diet issue. Some insurance companies will accept things like Weight Watchers, but some will not and require a "medically" supervised diet. It all comes down to your insurance and what they will accept.
How long you've been with your doctor has nothing to do with anything...
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