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07-09-2007, 03:35 PM
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#1 (permalink)
| | Cub Reporter
Join Date: Jul 2007 Location: Hagerstown, MD
Posts: 75
Weight Statistics July 11, 2007 Start Date:
April 15, 2008 Surgery Date:
5' 4"
Height:
315 lb Start Weight:
206 lb Current Weight:
150 lb Goal Weight:
109 lb Weight Loss:
56 lb Lb Left to Lose:
34.6031746032 % % Lost:
Body Mass Index54.0637207031 BMI Start:
35.3559570312 BMI Current:
25.7446289062 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
 |  Structured Diet Programs
Okay, so I talked to my insurance company today to get the lowdown on what is needed to be approved for surgery. My insurance company does cover the surgery, but one of the pre-requisites is that I need written documentation of one structured diet program in six months or two structured diet programs in three months. I'm a little confused....do I need to go and join weight watchers now??? I did it like six years ago, but I haven't done anything like that since. Or written documentation of a diet that my doctor would have placed me on and my doc has never done that. Is that what I need to do for the six months before surgery?? And then what are the guidelines? If I lose weight on it, will they not approve surgery?
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07-09-2007, 03:48 PM
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#2 (permalink)
| | Seasoned Veteran
Join Date: Jan 2006 Location: SOMEPLACE LONG ISLAND, NY
Posts: 6,809
Weight Statistics June 1, 2005 Start Date:
5' 5"
Height:
310 lb Start Weight:
167 lb Current Weight:
159 lb Goal Weight:
143 lb Weight Loss:
8 lb Lb Left to Lose:
46.1290322581 % % Lost:
Body Mass Index51.5810650888 BMI Start:
27.7872189349 BMI Current:
26.4560946746 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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((HUG))) sorry you have to go thru this.
I am sure others that had to go thru six month
supervised diets can give you the lo down.
I didnt have to do that but i hear my
insurance is now starting that requirement
as are many!
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07-09-2007, 06:02 PM
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#3 (permalink)
| | Seasoned Veteran
Join Date: Apr 2007 Location: NY
Posts: 10,174
Weight Statistics 4/19/2007 Surgery Date:
5' 9"
Height:
260 lb Start Weight:
152 lb Current Weight:
165 lb Goal Weight:
108 lb Weight Loss:
-13 lb Lb Left to Lose:
41.5384615385 % % Lost:
Body Mass Index38.3910943079 BMI Start:
22.4440243646 BMI Current:
24.36357908 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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oh man! im sorry you're having this bump in the road. I wasnt required either so I'm sorry i cant help. Just passing thru to lend some support.
__________________  KenyaR.  Lap RNY 4/19/07 | |
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07-10-2007, 07:13 AM
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#4 (permalink)
| | Seasoned Veteran
Join Date: Apr 2007 Location: Central Virginia
Posts: 2,952
Weight Statistics 4/30/2007 Start Date:
9/5/07 Surgery Date:
5' 4"
Height:
233 lb Start Weight:
127 lb Current Weight:
125 lb Goal Weight:
106 lb Weight Loss:
2 lb Lb Left to Lose:
45.4935622318 % % Lost:
Body Mass Index39.9899902344 BMI Start:
21.7971191406 BMI Current:
21.4538574219 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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It sounds like BC/BS. They've got the same line in my policy. My PCP sent them a letter saying I've been on many structured diets while under his care since 1997. I'm waiting to see if that's enough because my last successful weight loss/structured diet was in 2002-2003. I'll let you know if I hear.
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Highest 233, Lowest 122, Current 127
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07-10-2007, 07:36 AM
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#5 (permalink)
| | Seasoned Veteran
Join Date: Jan 2006 Location: SOMEPLACE LONG ISLAND, NY
Posts: 6,809
Weight Statistics June 1, 2005 Start Date:
5' 5"
Height:
310 lb Start Weight:
167 lb Current Weight:
159 lb Goal Weight:
143 lb Weight Loss:
8 lb Lb Left to Lose:
46.1290322581 % % Lost:
Body Mass Index51.5810650888 BMI Start:
27.7872189349 BMI Current:
26.4560946746 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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I had the BS/BC ppo .....
i know they have added this.
I know my PCP wrote a letter ot my surgeon for
part of the package but im clueless what it said.
I am sure it has said i been under his care for years
trying numerous diets.....not sure.
BE strong you will get thru this obstacle!
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07-10-2007, 09:31 AM
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#6 (permalink)
| | Whipper Snapper
Join Date: Jul 2007 Location: Pittsburgh, PA
Posts: 30
Weight Statistics Jan. 4, 2008 Surgery Date:
5' 4"
Height:
278 lb Start Weight:
230 lb Current Weight:
140 lb Goal Weight:
48 lb Weight Loss:
90 lb Lb Left to Lose:
17.2661870504 % % Lost:
January 2009 Goal Date:
Body Mass Index47.7133789062 BMI Start:
39.4750976562 BMI Current:
24.0283203125 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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KnitterGirl,
I have Highmark PPO Blue--not sure what you have. It requires a CONSECUTIVE 6 month physician monitored diet program--mine cannot be broken up 3 months and 3 months. It is also required that this 6 month diet be within the last 2 years. Beside the diet they require a consultation with a nutritionist and a consultation with a phsychiatrist. When we (my husband and I) met with out doctor the recommended a 6 month diet program that they offered so that is what we are now going thru. They said you could use your own PCP for this, but I knew that my PCP wouldnt go for WLS. So my husband and I decided to just do the diet program together--we already knew insurance accepted this program as the doctor had told us that many of her patients have went through this same program. And the people running the program are working with my doctor so they are actually teaching you want will be needed after surgery as well--not just a diet--a new lifestyle. Hope this helps
Beth
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07-10-2007, 03:47 PM
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#7 (permalink)
| | WLS Master Guru
Join Date: Apr 2007 Location: Near St. Louis, MO.
Posts: 961
Weight Statistics 04/17/2007 Start Date:
April 30, 2007 Surgery Date:
5' 5"
Height:
296 lb Start Weight:
160 lb Current Weight:
150 lb Goal Weight:
136 lb Weight Loss:
10 lb Lb Left to Lose:
45.9459459459 % % Lost:
05/21/2008 Goal Date:
Body Mass Index49.2515976331 BMI Start:
26.6224852071 BMI Current:
24.9585798817 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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I have BC/BS of CA and they didn't require me to have one either. Reading all of the problems that people have had has REALLY showed me how lucky I was in all of this.
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07-10-2007, 04:52 PM
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#8 (permalink)
| | Big Loser
Join Date: May 2007 Location: Florida
Posts: 197
Weight Statistics June 5, 2007 Start Date:
July 31, 2007 Surgery Date:
5' 5"
Height:
260 lb Start Weight:
145 lb Current Weight:
150 lb Goal Weight:
115 lb Weight Loss:
-5 lb Lb Left to Lose:
44.2307692308 % % Lost:
Dec 2008 Goal Date:
Body Mass Index43.2615384615 BMI Start:
24.1266272189 BMI Current:
24.9585798817 BMI Goal:
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Quote:
Originally Posted by not quite Barbie  It sounds like BC/BS. They've got the same line in my policy. My PCP sent them a letter saying I've been on many structured diets while under his care since 1997. I'm waiting to see if that's enough because my last successful weight loss/structured diet was in 2002-2003. I'll let you know if I hear. | My PCP did the same thing because I was seeing him while I did Weight Watchers. The letter from him was all they needed and it was BCBS.
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07-10-2007, 05:00 PM
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#9 (permalink)
| | Seasoned Veteran
Join Date: Aug 2006 Location: WADING RIVER (Long Island), NY
Posts: 5,122
Weight Statistics 7/16/07 Start Date:
7/16/07 Surgery Date:
4' 11"
Height:
230 lb Start Weight:
130 lb Current Weight:
115 lb Goal Weight:
100 lb Weight Loss:
15 lb Lb Left to Lose:
43.4782608696 % % Lost:
12/31/08 Goal Date:
Body Mass Index46.4492961793 BMI Start:
26.2539500144 BMI Current:
23.2246480896 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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HI
I ALSO HAVE BC/BS THEY DID REQUIRE THIS 6 MONTH DIET BUT MY PCP WROTE THEM A LETTER SAYING I HAVE BEEN UNDER HIS CARE FOR YEARS AND HAD FAILED DIETS AND EXCERCISE PROGRAMS AND THAT ITS GETTING HARDER FOR ME TO EXCERCISE SINCE IM STARTING TO HAVE PAIN IN THE HEELS OF MY FEET DUE TO MY WEIGHT. ( iwas never under an actual diet under his care but he wrote this for me.) HE ALSO SUPPLIED THEM WITH PROOF OF A MEMBERSHIP TO A GYM I WAS PART OF 2 YEARS AGO WHICH SHOW MY ATTENDANCE TO THE GYM (figured it would help). SORRY YOU HAVE TO GO THRU THIS BUT THE 6 MONTHS WILL HOPEFULLY FLY BY 
__________________ 230 lbs 7/2007 & 130 lbs 2/2009    | |
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