Jump to content
×
Are you looking for the BariatricPal Store? Go now!

 BIG NEWS! Several insurers are REMOVING supervised diet requirements



Recommended Posts

mg28olyfghi-300x169.jpg YOU MUST READ THIS if . . .

Your health coverage comes from Blue Cross Blue Shield of Illinois, Texas, Montana, New Mexico or Oklahoma in 2019! (And probably should read it even if you're not!)

Why? Those 5 companies are part of HEALTH CARE SERVICE CORPORATION (HCSC) and they are making a major change which affects anyone insured by them in 2019 who is considering having bariatric surgery. The HCSC Bariatric Surgery Medical Policy no. SURG716.003 is going to become effective February 1, 2019 and, believe it or not, they are eliminating any formal requirement that patients engage in supervised weight loss for a particular time frame (e.g. 3, 6, 12 months, etc.) prior to surgery.

READ MORE HERE: BIG NEWS! Several insurers are going to REMOVE pre-surgery supervised diet requirements

Share this post


Link to post
Share on other sites

Wow this can be major for all the Bariatuc Hopefuls! Thank You Walter for this update!

Share this post


Link to post
Share on other sites

I won't be surprised if most doctors and hospitals still have their own "bariatric program" They'll probably be similar in length just to stay competitive. Ultimately a lot of customers/patients are going to be looking at going to whatever place can get them to surgery day the quickest.

Share this post


Link to post
Share on other sites

OMG! My new insurance plan starting in Jan 2019 is Anthem Blue Cross Texas. I know bariatric is covered in my policy and there was literally nothing else mentioned for requirements in the EOC aside the surgery needing to be medically necessary and performed at a BDCSC facility. This is awesome news!!! Thanks for sharing!

Share this post


Link to post
Share on other sites

Thank you for sharing. I have Blue Cross Blue Shield of Massachusetts. I’m really confused because the doctor said I need 6 months of supervised diet whereas my insurance says that’s not necessary. Right now I need to reach out to another doctor to get a second opinion.

Share this post


Link to post
Share on other sites

I have a legitimate question, please? Speaking as a therapist and a RNY vet.

What is it about taking away the supervised program that is attractive to those of you that are seeking surgery? Is it that it takes away one of the multiple hoops we already have to jump through or is it that it shortens the length of time before scheduling surgery?

The biggest reason I ask is because it seems kind of scary for me because so many folks I work with (and folks here, too) are already saying that they felt so unprepared for life after surgery, I'm afraid that shortening the timeframes even more will make it even worse. So much of the medically supervised time should be for the "pre-work."

I just really worry that this is a secret way for insurance to come back later and say "see, this bariatric surgery thing isn't working. All these people are gaining their weight back. We should stop covering it."

I know, I know - it sounds like a conspiracy theory, but I deal with insurance companies not wanting to pay for services so often (3 sessions after a suicide attempt? Sure, that'll be plenty! [emoji849]), it just wouldn't surprise me. 🤷‍♀️

~SW: 278 CW: 165~
RNY 1/5/2005
"What got you here won't get you there."

Share this post


Link to post
Share on other sites

Sadly, I've confirmed that my insurance, Anthem Blue Cross (California), still requires dietician consults for 6 months. So I guess my Blue Cross plan is just not the same type of plan discussed in this article :(

Share this post


Link to post
Share on other sites

I have completed the seminar and turned in my paperwork to the surgeon's office.

I have BCBS IL and spoke to them on the phone last week. While they no longer are requiring the supervised diet to approve, they did say that surgeons may require their own supervised diet plans so it seems they are leaving it up to the surgeon but they don't require it.

Share this post


Link to post
Share on other sites

Exactly! It's a medical decision which should be reserved for physicians. However, I hope bariatric programs don't make mandatory diets a requirement of their programs as a knee-jerk reaction to insurer demands - even when insurers don't "demand"! Why? Because there is no evidence-based medicine to support mandatory diets! Here is more information to help:

ASMBS Position Statement On Insurer-Mandated Pre-Surgery Weight Loss Requirements

Share this post


Link to post
Share on other sites

My Anthem BCBS (California - Prudent Buyer plan) doesn't require supervised diets, but we still have to do 6 months with a dietician. I'm not required to lose anything.

Share this post


Link to post
Share on other sites

Exactly! It's a medical decision which should be reserved for physicians. However, I hope bariatric programs don't make mandatory diets a requirement of their programs as a knee-jerk reaction to insurer demands - even when insurers don't "demand"! Why? Because there is no evidence-based medicine to support mandatory diets! Here is more information to help:
ASMBS Position Statement On Insurer-Mandated Pre-Surgery Weight Loss Requirements
So I saw the surgeon today for the first time and he is going based off BCBSIL's requirements and expects me to have surgery in 2-3 months once I complete the nutritionist, psych and pre OP testing and everything is submitted to insurance for approval. No supervised diet required by my surgeon if insurance doesn't require it.

Sent from my SM-G960U using BariatricPal mobile app

Share this post


Link to post
Share on other sites

Here's the thing. I don't find value in not receiving nutritionist guidance from your surgeons office. On so many boards I see what am I supposed to eat questions. Well where was the guidance from your bariatric clinic

Sent from my moto e5 play using BariatricPal mobile app

Share this post


Link to post
Share on other sites

On 01/03/2019 at 00:02, Amanda Dutton LPC said:

I have a legitimate question, please? Speaking as a therapist and a RNY vet.

What is it about taking away the supervised program that is attractive to those of you that are seeking surgery? Is it that it takes away one of the multiple hoops we already have to jump through or is it that it shortens the length of time before scheduling surgery?

The biggest reason I ask is because it seems kind of scary for me because so many folks I work with (and folks here, too) are already saying that they felt so unprepared for life after surgery, I'm afraid that shortening the timeframes even more will make it even worse. So much of the medically supervised time should be for the "pre-work."

I just really worry that this is a secret way for insurance to come back later and say "see, this bariatric surgery thing isn't working. All these people are gaining their weight back. We should stop covering it."

I know, I know - it sounds like a conspiracy theory, but I deal with insurance companies not wanting to pay for services so often (3 sessions after a suicide attempt? Sure, that'll be plenty! [emoji849]), it just wouldn't surprise me. 🤷‍♀️

~SW: 278 CW: 165~
RNY 1/5/2005
"What got you here won't get you there."

I agree with this post 100 percent! I think we need the time to get our head in the right place. I have my surgery in 3 weeks and I know I would not have been as successful if I wasn’t forced to jump through these hoops. Only time will tell how successful I am in the long run. I hope doctors continue to require at least 4-6 months

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • Prdgrdma

      So I guess after gastric bypass surgery, I cant eat flock chips because they are fried???  They sell them on here so I thought I could have them. So high in protein and no carbs.  They don't bother me at all.  Help. 
      · 1 reply
      1. NickelChip

        It's possible for a very high fat meal to cause dumping in some (30% or so) gastric bypass patients, although it's more likely to be triggered by high sugar, or by the high fat/high sugar combo (think ice cream, donuts). Dietitians will tell you to never do anything that isn't 100% healthy ever again. Realistically, you should aim for a good balance of protein, carbs, and fat each day. Should you eat fried foods every day? No. Is it possible they will make you sick? Maybe. Is it okay to eat some to see what happens and have them for a treat every now and again? Yes.

    • NovelTee

      I'm not at all hungry on this liquid pre-op diet, but I miss the sensation of chewing. It's been about two weeks––surgery is in two days––and I can't imagine how I'll feel a couple of weeks post-op. Tonight, I randomly stumbled upon a mukbang channel on YouTube, and it was strangely soothing... is it just me, or is this a thing? 
      · 1 reply
      1. NickelChip

        I actually watched cooking shows during my pre-op, like Great British Baking Show. It was a little bizarre, but didn't make me hungry. I think it was also soothing in a way.

    • Clueless_girl

      How do you figure out what your ideal weight should be? I've had a figure in my head for years, but after 3 mths of recovery I'm already almost there. So maybe my goal should be lower?
      · 3 replies
      1. NickelChip

        Well, there is actually a formula for "Ideal Body Weight" and you can use a calculator to figure it out for you. This one also does an adjusted weight for a person who starts out overweight or obese. https://www.mdcalc.com/calc/68/ideal-body-weight-adjusted-body-weight

        I would use that as a starting point, and then just see how you feel as you lose. How you look and feel is more important than a number.

      2. Clueless_girl

        I did find different calculators but I couldn't find any that accounted for body frame. But you're right, it is just a number. It was just disheartening to see that although I lost 60% of my excess weight, it's still not in the "normal/healthy" range..

      3. NickelChip

        I think it's important to remember that the weight charts and BMI ranges were developed a very long time ago and only intended to be applied to people who have never been overweight or obese. Those numbers aren't for us. When you are larger, especially for a long time, your body develops extra bone to support the weight. Your organs get a little bigger to handle the extra mass. Your entire infrastructure increases so you can support and function with the extra weight. That doesn't all go away just because you burn off the excess fat. If you still had a pair of jeans from your skinniest point in life and then lost weight to get to the exact number on the scale you were when those jeans fit you, chances are they would be a little baggy now because you would actually be thinner than you were, even though the scale and the BMI chart disagree. When in doubt, listen to the jeans, not the scale!

    • Aunty Mamo

      Tomorrow marks two weeks since surgery day and while I'm feeling remarkably well and going about just about every normal activity, I did wind up with a surface abscess on on of my incision sights and was put on an antibiotic that made me so impacted that it took me more than two hours to eliminate yesterday and scared the hell out of me. Now there's Miralax in all my beverages that aren't Smooth Move tea. I cannot experience that again. I shouldn't have to take Ativan to go to the lady's. I really looking forward to my body getting with the program again. 
      I'm in day three of the "puree" stage of eating and despite the strange textures, all of the savory flavors seem decadent. 
      I timed this surgery so that I'd be recovering during my spring break. That was a good plan. Today is a state holiday and the final day of break. I feel really strong to return to school tomorrow. 
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      Now that I'm in maintenance mode, I'm getting a into a routine for my meals. Every day, I start out with 8-16 ounces of water, and then a proffee, which I have come to look forward to even the night before. My proffees are simply a black coffee with a protein powder added. There are three products that I cycle through: Premier Vanilla, Orgain Vanilla, and Dymatize Vanilla.
      For second breakfast on workdays, I will have a low-fat yogurt with two tablespoons of PBFit and two teaspoons of no sugar added dried cherries. I will have ingested 35-45 grams of protein at this point between the two breakfasts, with 250-285 calories, and about 20 carbs.
      For second breakfast on non-workdays, I will prepare two servings of plain, instant oatmeal with a tablespoon of an olive oil-based spread. This means I will have had 34 grams of protein, 365 calories, and 38 carbs. Non-workdays are when I am being very active with training sessions, so I allow myself more carbohydrate fuel.
      Snacks on any day are always mixed nuts, even when I am travelling. I will have 0.2 cups of a blend that I make myself. It consists of dry roasted peanuts, cashews, pumpkin seeds, sunflower seeds, pistachios, and Brazil nuts. This is 5 grams of protein, 163 calories, and 7 carbs.
      Breakfast and snacks have been the easiest to nail down. Lunch and dinner have more variables, and I prepare enough for leftovers. I concentrate on protein first, and then add vegetables. Typically tempeh, tofu, or Field Roast products with roasted or sautéed vegetables. Today, I will be eating leftovers from last night. Two ounces of tempeh with four ounces of roasted vegetables that consist of red and yellow sweet peppers, sweet potatoes, small purple potatoes, zucchini, and carrots. I will add a tablespoon of olive oil-based spread, break up 3 walnuts to sprinkle of top, and garnish with two tablespoons of grated Parmesan cheese. This particular meal will be 19 grams of protein, 377 calories, and 28 grams of carbs. Bear in mind that I do eat more carbs when I am not working, and I focus on ingesting healthy carbs instead of breads/crackers/chips/crisps.
      It's a helluva journey and I'm thankful to be on it!
       
      · 0 replies
      1. This update has no replies.
  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×