Medical Weight Loss Solutions
By Denise Mann
If you are considering bariatric surgery, you are probably well aware that most insurance companies require participation in a medically-supervised weight loss program for six months before they will consider covering the costs of weight loss surgery.
But what does this mean in real terms?
You have probably been on and off of diets for your whole life with limited success. Does this count? Not usually, says Joe Colella, MD, the director of Robotic Surgery at Magee Women's Hospital at the University of Pittsburgh Medical Center and an Assistant Professor of Surgery at the University of Pittsburgh Medical School. Colella is the author of Skinny People Just Don't Get It.
For it to count, "you have to go through a six-month sequential program of visits with your primary care doctor or some sanctioned programs that are recognized by your insurance plan," Colella says.
Colella and The Consumer Guide to Bariatric Surgery want to make it easier for prospective patients to meet insurance requirements for medical weight loss programs.
What is a Medical Weight Loss Program?
Medically supervised weight-loss programs are doctor-supervised weight-loss programs that take place in a clinical setting. They can be run by a medical doctor, nurse, registered dietitian and/or a psychologist. Each program is different in terms of what they expect and involve. Most typically include nutrition education, physical activity and behavioral therapy. Some involve the use of food diaries and regular weigh-ins. The frequency of and interval between follow-up visits is determined on an individual basis. Some are monthly until initial weight-loss goals are met.
Medical weight loss programs rarely involve the use of medications to produce weight loss. Your physician may prescribe medications to treat conditions associated with obesity such as high blood pressure, high cholesterol or diabetes.
Starting a Medical Weight Loss Plan
The first step is usually a visit with your primary care doctor. "Your doctor will give you an overview of your weight and discuss how it is a health concern," Colella says. These visits also include some basic advice about eating better and exercising more. Individuals with a body mass index (BMI) of 40 or higher who express an interest in gastric bypass, gastric sleeve or another weight loss surgery may be referred to a bariatric surgeon during this visit.
To maximize your chances of getting your surgery covered by insurance in a timely, hassle-free fashion, keep copious records and document all of your weight loss efforts, including the appointments with your primary care physician. "Be preemptive and discuss documentation as soon as possible so it can be done at that moment," says Colella.
While at your appointment, ask your doctor for a referral to a weight loss program. Some bariatric surgeons may have information on local programs as well.
Some health insurance companies may cover some or all of your program, so another good way to start is to call your insurer and see which local medically-supervised weight loss programs are approved.
So, what are you waiting for? Jumpstart the process now by finding a local bariatric surgeon.
Shawn M. Garber, MD, FACS, FASMBS
Spencer A. Holover, MD, FACS, FASMBS
John D. Angstadt, MD, FACS, FASMBS
Eric A. Sommer, MD
Nikhilesh Sekhar, MD, FACS, FASMBS
The New York Bariatric Group
275 Seventh Avenue
New York, NY 10001
NYU Medical Center
530 First Avenue
New York City, NY 10016
North Shore University Hospital
300 Community Drive
Manhasset, NY 11030