What diet do insurance companies require prior to bariatric surgery?
Insurance companies are making it more and more difficult to get authorization for bariatric surgery. Nearly all insurance companies require some form of physician documented weight loss program of between 3-6 months to satisfy their internal regulations to obtain authorization. This is why it is imperative that once you even begin contemplating surgery that you begin a physician supervised diet and understand what your specific insurance company’s required documentation is. The majority of insurance companies want those visits to focus on three areas; the type of diet, some form of exercise plan or recommendation, and a behavior modification that the patient is implementing. The type of diet can be a commercial diet such as Atkins or Weight Watchers, or can focus on a specific calorie restriction or limit. Exercise plans can be a detailed day by day workout plan, or as simple as recommending 30 minutes of cardio exercise three times a week. Finally, behavior modification should be addressed to include recommendations such as not shopping when you are hungry, or shopping only for foods along the perimeter or a grocery store as to avoid purchasing processed foods which are typically located in the center of the grocery store. Regardless of what type of diet, specific exercise plan, or guide for behavior modification, the insurance requirements for weight loss documentation are nearly always the most lengthy wait for surgical approval, and therefore, we recommend getting started as soon as possible if you are thinking about having bariatric surgery.
On another important note, we personally ask patients weighing 300 pounds or more to go on a 2 week protein shake diet just prior to surgery. This diet consists of 3 protein shakes daily totaling roughly 1000 calories.The diet’s purpose is to reduce fat in the abdomen and shrink the liver in order to make the procedure as safe as possible and easier to perform. All other patients we ask to be on a 24 hour clear liquid diet that can include broth or a clear protein such as Isopure to accomplish a similar goal of reducing the size of the liver. The goal of this diet once again is not weight loss but reducing the size of the liver to improve surgical safety.-Jamie Clarke
I think the recommendations outlined in this blog segment makes excellent points, especially with preoperative weight loss 2 weeks prior to surgery to shrink the liver. This definitely makes bariatric surgery or weight loss surgery, whether its the gastric sleeve, lap band, duodenal switch, or gastric bypass, safer for the surgeon as the stomach lies beneath the liver.
That being said, insurance companies requiring 3-6 months of medically supervised weight loss is not based on scientific evidence. There is no evidence that this improves patient outcomes. It is essentially a “hoop” for patients to jump through that is manufactured by the insurance companies.
My recommendation is for the 2 week diet and if a patient is able to, to self-fund their surgery and bypass the insurance requirements if it is feasible for them.
I got in touch with Brian Grace sent him my copies of my insurance card he has not got back to me. I called my insurance company they informed me that I need my PCP to get a Prior authorization request for surgery for the insurance company to approve my surgery and cover it fully. I’m calling my doctor and ask her to submit this request. My question to you is if the request was OK by the insurance co and they are fully covering my procedure would you do my surgery ??