I apparently have an unusual insurance question on my hands because my insurance company doesn’t seem to be understanding my question. For surgery approval, I am required to do six months of weight loss appointments with my general practitioner. At my initial consultation my bariatric surgeon told me to be very careful with how I do my six months of appointments because he’s had patients mess up and not get approved because of the how they did their 6 months due to their insurance companies being very strict.
What I’m wanting to know is do my appointments need to be spread out 30 days apart, which is going to be really hard to do with my doctors busy schedule, or can they just be once a month without regard to the number of days in between? All of my appointments are pretty much at least 20 days apart except for one appointment that’s I think 17 days apart.
I did reach out to my surgeons office first but was told that I need to contact the insurance company to find that particular detail out and when I call them I get the runaround. I have Anthem BC/BS.
I’m sorry if this is a really stupid question. I’m terrified of messing this up!

I think it's once every month so Like June July August but it really is up to the surgeon or the insurance

I have Anthem and they required six nutrition classes. The key was to do one class a month and not finish the six months early, or I would have to start over again. So, my first class was March 21, and my last class had to be after October 21. I imagine it would be the same structure with seeing a doctor.

I would imagine they have to be ABOUT 30 days apart, not necessarily exactly. But I'd call the insurance company about that 17 day one. They may be fine with it, or if not, maybe you can arrange to see someone else at your medical clinic for that one time?

Yes, 30 days apart or a day more... My nutritionist said these submissions were very important to be a month apart. Insurance companies are pretty strict.

Thanks y’all! I’ve been seeing my general practitioner instead of my bariatric surgeon for the monthly appointments because the surgeon is about 45 minutes away. I’m thinking about changing over to doing these appointments with the bariatric surgeon though since they know exactly what insurance requires. I might lose three months of progress if I do that but hopefully not.

I have Anthem BCBS and It had to be 30 days apart or a few days more, and you can't miss one appointment or you have to statt all over! Ah, the hoops we jump through for insurance approval!!

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My insurance person told me that I had to be very careful about these dates. For example, if I had an appointment with my personal physician near the end of October, my next appointment had to be no later than 30 November. If the appointment was 1 December, the insurance would make me start over. I have medicare/tricare.

The truly absurd thing about this three month weight monitoring/control thing was there is no requirement to gain/lose weight. Why do it?

The answer is this: as an insurance commissioner told me, insurance companies look for any reason/excuse to refuse to pay. Fortunately, I knew a man who knew the commissioner who had to threaten them with loss of license to get them to pay.

Edited January 17, 20206 yr by Duke483

I have Aetna and they require 90 day physician supervised weight management. Main thing my surgeon said was to make sure last visit was on or after day 90 or I would be rejected. I did monthly visits about 4 weeks apart with my last visit on day 91. I started in middle of the month around the 15th to make sure I could get each month visit in without worrying about running into the next month. Also make sure your PCP clearly notes that your visit is for weight management and not just a general visit or they can reject for that. Just the hoops you have to jump through.

I have Aetna and they require 90 day physician supervised weight management. Main thing my surgeon said was to make sure last visit was on or after day 90 or I would be rejected. I did monthly visits about 4 weeks apart with my last visit on day 91. I started in middle of the month around the 15th to make sure I could get each month visit in without worrying about running into the next month. Also make sure your PCP clearly notes that your visit is for weight management and not just a general visit or they can reject for that. Just the hoops you have to jump through.

I've decided to start all over with appointments at the bariatric center I'll be getting surgery with. They know exactly what insurance needs so it'll be much more simple. I'm losing 3 months of progress but I'd rather do this now instead of getting to month 6 with my current doc only to be told it was done wrong. I didn't do this originally because it's a long way to drive each month but my sanity is worth it! ? Thank you all for your feedback!