12 Month Medically Supervised Weight Loss Requirement?!?!?!?

[Allison4283 7]

Hi everyone! I am new and SO glad I found this site! I have already gained so much knowledge reading through the forums.

So. I got really excited because the company I work for added the bariatric surgery benefit to my coverage this year. However, they require a TWELVE MONTH supervised preoperative weight loss program. I have been overweight since elementary school. I have tried almost every diet known to man. I lose weight, then gain it all back-PLUS MORE! I have been researching bariatric surgery for years, so I expected a 3 to 6 month required diet. I just wasn't expecting a year. Has anyone else had this as a requirement and somehow got the time frame shortened? My BMI is in the 60's and I have comorbidities of sleep apnea, and I am borderline diabetic. My medical records show a steady increase of weight over the past 11 years. Help!

[Thinny 30]

Check the wording. Does it have to be 12 months of 'consecutive' visits. Your PCP should be able to put together a list of all your attempts and the meds that were prescribed. Mine doesn't say consecutive so I was able to have the doctor list all my attempts and my weight at each visit. That was enough -and- by the time you finish all the appmts and get a surgery date you should have at least two-three months at your bariatric doctors' nutritionist. See, how that makes things a little better.

Don't mind if people tell you to 'use that time to get educated'. As if you're not reading everything you can get your hands on.... It's your journey. If you want it now you want it now.

[Allison4283 7]

It does NOT say consecutive. The wording specifically says: "Participant has complied for at least 12 months within the 15 month period prior to the scheduled surgery in such a program, which is documented in the medical record by the attending physician who supervised the Participant's participation at each visit" Kinda sounds a little off.... So I think my next step will be to gather my records from office visits in the past 15 months. I was in a program for several months that monitored my diet and exercise, but she was not a physician. Thanks for the info!

[Thinny 30]

This is a great start. Good luck.

[Barry W 336]

I can understand your frustration. Perhaps you can also try contacting others in your area who have had weight loss surgery to see if another company offering insurance there has less stringent requirements, and see if you can switch insurance?

[Wia 4]

Hello,

I would call your insurance co. again and get specifics. Be sure to tell them it's for bariatric surgery. The rules are sometimes different depending on the procedure. Mine used to be 3 months but went to 6 months by the time I decided to go through with it. If you already have a dr. they might know as well. My surgeons office was very well informed and helped me alot. Sometimes you need to call the insurance co. several times before you get someone that really knows the correct info too! Make sure you get names and reference numbers from your call in case you need to refer back to the info you were told -very important! Good luck!

Sent from my iPhone using the BariatricPal App

[Allison4283 7]

Thanks for the info. My coverage is through my employer and happens to be a self funded plan.....so the employer basically makes their own rules about benefits and they are specific to the company I work for-unlike if you had a standard BCBS of TN plan or something. There isn't another plan to switch to; the few options offered all cover bariatric surgery now. There's about 2 or 3 paragraphs describing the requirements, but it is still pretty vague. I am almost afraid to call and ask for more details about requirements-wouldn't that wave a red flag?

[Thinny 30]

Yes and no. This can skulls be probate but you have to do it. The insurance coordinator at my Dr office called and got all my require and sent in a pre- authorization as well. That locks them in to defining requirements.

That should say...the call should be private...