Why You Should Consider a Medically Supervised Weight Loss Program

WHY YOU SHOULD CONSIDER A MEDICALLY SUPERVISED WEIGHT LOSS PROGRAM

The road to getting weight loss surgery can be long and very often frustrating. If you are considering surgery, but are still in the investigational phase, there are some things you can do to make that process a bit easier when you seek approval from your insurance company.

The first thing that you must understand is that most, if not all insurance plans, are mow requiring documentation of non-surgical, medically or professionally supervised weight loss efforts before allowing access to surgery. This is frustrating for the policyholder who has truly “been there – done that” and does not believe or understand why “yet another diet” is needed. The problem comes when the insurance company asks you to “prove” those efforts.

Such proof can be hard to come by, especially since you don’t know when you’re going through those efforts or programs that proof may be required sometime. Insurance companies are counting on that being a basis for delay or outright denial. We encourage you to contact your insurance company representative and obtain your policy specific criteria.

On the other hand, many of you either haven’t decided to have surgery or are waiting for various appointments prior to submitting the request for approval to your insurance plan. This is where weight loss programs started as soon as possible can help you. First, any bariatric surgeon will agree that there are health benefits to losing weight prior to surgery, and such weight loss may make you a better and safer candidate for surgery. However, from the insurance approval perspective, some of the best advice we can give to lead to your approval is to immediately get on a medically supervised weight loss plan of some type. You’ll be surprised how fast the time goes while you’re waiting on consultation appointments and other program requirements and it will help make the insurance submission easier and less likely to be denied in regards to documented weight loss attempts.

Many primary care doctors can assist you in developing a plan that is easy to follow and document. There are commercial plans which may or may not be covered by your insurance provider that are available to you. While you are completing the preoperative process, waiting for appointments or deciding on your options during this process, use the time wisely by enrolled in a documented medically supervised weight loss program.

People often ask how long such a program can or should last. From the insurance approval perspective only, many insurers are looking for 6 consecutive months of documentation that includes monthly weigh-ins and counseling on the plan signed by the physician. Cigna, Aetna and UPMC are examples of insurance companies looking for that type of criteria.

Ways to document your weight loss efforts include copies of your medical record. You should be sure to have your doctor put on your medical chart that he/she is working with you on weight loss and supervising your efforts. Sometimes doctors fail to accurately document all the counseling and discussions; just let them know your insurance company is interested in knowing how hard you’re trying to lose weight in the event surgery becomes medically necessary.

Other documentation of past weight loss attempts could be computer printouts from the pharmacy for medications such as Meridia, Phentermine, Xenical, Phen-Fen or Redux. As well as receipts for any over the counter weight loss medication you may have taken in the past. If you’re involved with a commercial plan like Weight Watchers, Jenny Craig or similar programs, you can get letters or receipts for documentation.

Remember, we aren’t suggesting this because we don’t think bariatric surgery is a good idea or because we don’t appreciate that you’ve been on multiple diets and weight loss programs in the past. But we see far too many prospective patients be denied simply because no one told them ahead of time how very important documentation of weight loss efforts could be for insurance company looking for a reason to say “NO”. Don’t be one of those people, play the game and it may help you get the desired approval faster, and without a long appeal or grievance.