Beginning on
January 2, 2006, TennCare enrollees 10 years of age or
older who have BMI above 30, or have a doctor's referral,
may enroll in a 12-week Weight Watchers program. A doctor's
referral will be required for all children aged 10-17.
Participation in the program is not open to pregnant women
or individuals with diagnosed eating disorders. The program
will be offered statewide, in every county.
Per recommendations, the doctor's referral for enrollees
with a BMI below 30 should be for reasons of medical necessity,
when there is a negative impact on the enrollee's health
(due to their weight). TennCare would also like the targeted
weight loss goals to be identified on the referral. The referral
should be in writing; no specific form is required. The enrollee
needs to bring the referral to the initial meeting.
Enrollees can call Weight Watchers at 1-800-651-600 to pre-register
or they can attend a local meeting in their area to be determined
eligible for the program. Adult enrollees (21 and over) will
be required to pay a $1.00 co-pay at each weekly meeting,
as well as present their TennCare ID card.
Weight Watchers will determine eligibility for the Weight
Watchers program and check the enrollee's TeenCare eligibility
via Tennessee Anytime. Weight Watchers must obtain prior
authorization for each participant from the member's TennCare
MCO. For prior authorization, please call Health Services
Department, Outpatient Services at: (615) 782-7800 option
3 ext. 3050. Enrollees who attend at least 10 weekly meetings
in the 12-week period, achieve their targeted weight loss
for the period and complete an exit survey will be eligible
to participate in an additional 12-week program.
VHP CommunityCare will also provide transportation to and
from meetings for individuals needing such assistance. Members
may call 1-877-883-2889 to request assistance with transportation.
If you need further information on the Weight Watchers partnership,
please contact Nancy Walden RN, EPSDT coordinator by telephone
at 615-782-7915 or e-mail: nwalden@windsorhealthgroup.com.
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