Healthcare at West Virginia University

Bariatric Surgery

Medically Supervised Weight Loss Program

For weight loss surgery to be covered by health insurance, most insurance companies require patients to have made a serious effort to lose weight by other means. In general, they require participation in a medically supervised weight loss program for a period that varies from several months to a year or more.

There are strict standards that determine whether or not a weight loss program can be considered medically supervised:

The program needs to consist of regular follow-up visits with a medical professional (physician, physician’s assistant, nurse practitioner, dietitian).
Documentation of these follow-up visits is required. This must include the patient’s weight, pounds gained or lost, identification of the specific diet plan or prescribed diet medication, type and frequency of exercise, and description of behavior modification practices.
Participation in a program must be documented in the patient record. (Weight Watchers, TOPS, and other programs may qualify as medically supervised weight loss programs if you follow up with a health professional who documents your results in your medical record.)
Generally, the medically supervised weight loss program must have occurred within one to two years prior to weight loss surgery.

After completing the required period of medically supervised weight loss, you must send a copy of the actual progress notes from your medical record to your insurance company to obtain pre-authorization for the weight-loss surgery.

A staff member from the WVU Surgical Weight Loss Program can work with you to be sure that you meet your insurance company’s requirement for participation in a medically supervised weight loss program.

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Bariatric Surgery

Medically Supervised Weight Loss Program