6 month diet requirements

[2bfit 62]

I have heard that if you have already been on a medically supervised weight loss plan for more than 6 months, that those records are ok to submit to satisfy the 6 month supervised diet criteria. Is this true? Does anybody have any input on this?

[M2G 1,836]

My specific plan stated that it could be submitted but it had with a dr., registered nurse, or registered dietician. I don't know how strict some of the weigh loss plans (like WW, Jenny Craig, and other diet-type centers are but I am not sure that they strictly employ "registered" dieticians.) I think a lot of WW leaders are people who have had success with the plan and believe in it, and go on to become leaders (again I don't know what their process is at WW.)

And of course it all had to be documented. And you couldn't skip a month, etc. It had to be 6 consecutive months. I'd done a million diets over the last 18 years but only had documentation on a few of them. Plus they all had to be within the last year. So doing WW 5 years ago doesn't count.

Wish I had more concrete information and maybe someone who's plan was accepted for approval will come along here and spell out what rules they had to follow. I would say generally *most* insurance companies want you to START OVER and then can ask for specific documentation instead of accepting someone elses documentation. Sorry, wish I had better news for you!

[2bfit 62]

As of right now I am not sure what to think. I had heard that it could be any detailed documentation in the last couple of years. I actually went to a doctors weight clinic and had a physical, B12 injections and phentermine for 2 years. So they have 2 years of weigh ins for about 2 to 3 visits a week. I was lucky to have all of that documented for so long. I went from March 2008 to March 2010 because I could not afford it anymore. I know for certain that those medical records were the reason I was able to even have the consult with the surgeon. At first I was denied because they wanted me to at least show "motivated" attempts at weight loss even though I had a BMI of 40. When my primary doctor sent those records in I immediately got approved for the consult. I am going to meet with their weight loss program department tomorrow. I am going to give him a copy of all of my records and receipts from all the diets I have tried. I seriously do not know what he can do for me. The NUT I am seeing is having me read a book called "Intuitive Eating" it's a great read and I recommend it but it does not agree with the diet mentality. So it's a big game and song and dance.

Right now I am battling with the medical group to get the surgery approved. They keep changing their tune. They are now saying I have to have a BMI of 35 with one comorbidity to be approved for surgery. According to UHC (the insurance) they follow the NIH guidelines for bariatric surgery. Based on the appeal letter I received directly from UHC (not the medical group) they clearly indicate that you can have a BMI of 40 with no comorbidities to have the surgery or 35-39 with certain specific comorbidities.

I used to work with medical groups so I kind of have an inside on how they operate. When you have an *** you choose a PCP and a medical group who are supposed to be in charge of all of your healthcare needs. The medical group receives their money from the insurance company for your care. That is why the medical group is fighting so hard to deny the surgery. They are the ones who actually have to fork over the money because in all actuality they have already been paid for my care by the insurance company. Basically the less your doctor has to see you the more money the medical group can hold on to.

It's a sick game but in the end like most things it's about profit. I will let you know if I find out anything about the diet requirements or if what I submitted works.

[M2G 1,836]

Cheri, I do think that each plan is very specific and while UHC may have some generalized guidelines, there are still little details that change per plan. I would absolutely TRY to submit any and all records you have to get out of whatever waiting period is needed, but don't pin all your hopes on their requirements being satisfied.

I spoke with my PCP because I was concerned about my husband. He did all of his monthly (6 of them) weigh-ins at my PCP's office while I went another route and used my surgeon's office (our PCP is MUCH more convenient for my husbands schedule and MUCH closer to our home whereas the surgeon's office is a good 45 minute drive.) Anyway, I was concerned about my husband getting "denied" based on him seeing them vs. the surgeon and guess what? My PCP told me he had someone that had UHC and they did all the required check-ins and the man was waiting for bypass surgery. They denied him (obv. not sure of the specifics of "why") but in the meantime the man developed diabetes, HPB and high cholesterol. Isn't that awful?

My husband was approved without a problem, so that was a big sigh of relief.

Also I did check with a WW leader who goes to my Curves. She has been a WW Leader for over 20+ years. The WW leaders do NOT have to be registered dieticians...so I guess it would give UHC grounds for denial.

Also our plan stipulated that it was BMI of 35-39.9 with at least ONE co-morbidity (and it actually spelled out which ones would qualify as a co-morb) OR a BMI of 40.0+ or greater, no co-morb needed. I fell into the 40+ category and my husband did too (just barely) but he also had a covered co-morb so he would have been approved even if his BMI had slipped below 40, whereas my BMI HAD to stay above 40+ the entire duration of the 6 months of check-ins. My UHC nurse case manager made sure to spell that out for me that I could NOT slip below 40...I appreciated her honesty. It is ALSO part of the reason that I did not do any type of pre-op diet, of course I could have lost a few lbs since my BMI 4 points above the danger line, but I wasn't planning on risking denial over my BMI!!!

Good luck, do not give up, that is what they want!!!

[2bfit 62]

Thank you for the words of encouragement! I just faxed over my 21 page appeal letter. I am going to blind them with paperwork! Actually the appeal was only 3 pages and the rest was supporting documentation, from receipts, to gym membership, to the 2 year weigh ins I had with the medically supervised weight program. I also threw in the NIH guidelines and the guidelines they specified to me when they first denied my consult.

I think it is sad how they play with peoples emotions. I went to see the medical groups weight doctor and my BP was 142/80! I have never been that high. In fact when I first started this process my BP was 107/69! I can very easily see how people develop problems during this process. All I can think is I am this close to being approved if they have to keep changing their requirements to deny me. So I will keep the pressure on!

OH! Did I mention that I met with the NUT and weight doctor on the same day? When I met with the weight doctor he wanted me to join Medifast. I told my NUT and she is dead set against it. She said she is going to document her opinion as to why she disagrees. So now what do I do!? I don't want the insurance to think I am not being compliant so I put that information in my appeal letter. I think a registered NUT would know more about nutrition that a PA...no offense to the PA but the NUT told me they get kick backs and that's why the push the Medifast plan.

I read your other post and I am in the same boat. I am right at 40 BMI. So I have stopped exercising because I cannot afford to lose a single pound right now. I need this approved!

Did your husband have to do a 6 month diet? Or just weigh in?

My husband is 6'3 and 300lbs with high blood pressure and high triglycerides so I am wondering how hard it will be for him to get approved? I am thinking not as hard as it's been for me since I did not have a qualifying comorb.

I will keep you posted. I hope to hear something soon because I want to get this weight off! :funscale: