6 month supervised diet help needed... - ThinnerTimes

dutchgirl · 03-09-2006, 11:07 PM

I posted yesterday that I was denied a bariatric surgeon consult because I needed to complete a 6 month supervised diet with a physician.

First off, I was wondering if they can deny the consult because of this. I know they can deny it for the surgery, but I'm not sure about the consult. Anyone who had any experience appealing this would be helpful..

Secondly, did anyone who had done the required 6 month med. supv. diet have any problems getting approved once completed.

Thirdly, is there anything during this process I should be aware of? My PCP was surprised I wasn't approved for the consult and feels I should have the surgery. He is really making sure everything is documented, I.E. my hypertension, back pain, depression, acid reflux, etc.... If there is anything else anyone thinks is important to the documentation?

Also, I have Health Net and when I called about the criteria to meet for surgery, besides the 6 month diet and the BMI, it stated that the patient must have been obese for 5 years. Has anyone had this be an issue? I mean I'll have only been seeing this doctor for 6 months. Does the doctor just need to document that I have said how long I have been obese?

Please, please, please any help or information would be appreciated and would also help me to keep my focus off how devastated I am about how I now have to wait another 6 months...I am just so depressed about having to go through another summer this way...

cnvh · 03-10-2006, 07:56 AM

Well, from your insurance's point of view, why should they pay for a consult if you have to do the 6-month supervised diet first anyway, and they'd just have to pay for a SECOND consult again before surgery? (Not agreeing with it, just guessing at their perspective.)

My insurance is similar in that it requires the 6-month supervised diet... So far in the past month and a half, I have spoken with my PCP, who in turn referred me to a nutritionist, who in turn referred me to my hospital's WLS program, where (apparently) I'll be doing the 6-month supervised diet through them. So even though I began working towards this almost 2 months ago, I probably still haven't started that 6-month clock ticking yet! (That's OK though, at this point I'm happy just to be moving forward with the process rather than rushing it!)

So unfortunately Dutchgirl, I can't offer you much in the way of info yet. All I can say is, dealing with the hoops the insurance company holds out just takes a LOT of patience. Relax and try not to get too frustrated; it will happen if you are patient but perisistent!

Doc J · 03-10-2006, 08:36 AM

Since you have been seeing your current PCP for only 6 months, you don't have enough "History". Getting your records from your previous Dr(s). may help. Remember, they are your records! They may put you through some hassles to obtain them, but by law they are yours and they have to release them to you and / or you current PCP.
As you go through this journey, you will discover that you will have to be your own advocate to cut through all the red tape.
Good Luck on your journey.

Zenomia · 03-10-2006, 02:41 PM

Like John said...get your records. It's all well and good to document your past history, if your PCP has it already in your records. If your Dr. already has a complete set, GET THEM!!! Go through them, each and every appt. where you were weighed in and highlight it! That alone will prove your weight problems for an extensive amount of time. For me I was up and down, all over the board, but once I charted it, over a time period of 15 years, anyone could see that my average was MO...even when I was thinner at times. It also helps if the Drs. have made notations that you have talked about your weight or given ideas about obesity. ANY time a Dr. makes note of that...it can be considered a Weight Related VISIT...therefore qualifying.

You just need to get ALL of your medical records for the past 10 years and go over them with a fine tooth comb. Actually, I found mine to be very, very interesting. I learned that I had compressed disks in my back that had been found during an MRI I had for something unrelated to back pain!!

Imagine my surprise on that one....8 years later realizing my back has hurt for all this time, and someone KNEW why...and didn't tell me!

Even if you are done with this surgery it is a good idea to look over your medical records every 5 years or so....just to be sure that what they are telling you in the office is the SAME thing they are documenting in your records!!

GOOD LUCK!