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BCBS Federal Requirements for Lap Band

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Started by BigOBoy123, Mar 05, 2013 3:54 PM
6 month diet documentation
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40 replies to this topic

    BigOBoy123

    Senior Member

  • Posts: 99
  • Joined: Mar 2013
  • Surgery: LAP-BAND
  • Surgery Date: Jun 2013
  • Starting Weight: 309 lbs
  • Weight Lost: 31 lbs
  • Current Weight: 278 lbs
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Posted March 5, 2013 - 3:54 PM

#1
I am in the beginning stages of getting my lap band and I need to know if BCBS Federal Basic requires 6 consecutive months of documentation of me being on a diet plan from a doctor. I read on a website that BCBS as of April 2012 did not require this documentation. Is this true. I hope it is. Thanks.


    muelle

    Guru in Training

  • Posts: 260
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Posted March 5, 2013 - 4:05 PM

#2
I know every BC/BS plan is different. I have Highmark BC/BS and they do require the six month supervised diet. I had my surgery two years ago and my daughter had hers two weeks ago. It took 18 months and two different six month supervised diets to get my daughter approved. They denied her the second time and I appealed it. They said she had to see a nutritionist and a doctor every month, and she had only been seeing the doctor. Fortunately they approved the appeal, but I recommend you call your insurance and have them send you the requirements in writing and ask them to specifically explain the requirements to you. It is heartbreaking to jump through all the hoops and get denied. Good luck to you!!!


    grownazzkid

    Expert Member

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Posted March 5, 2013 - 4:05 PM

#3
I have BCBS Fed and was just banded 2/21. I went to True Results clinic in Austin. Three month of diet counseling and two years of medcial history (from regular doctor) indicating that you have been 40+ BMI (or under 40 & 2 co-morbids liek high bp, sleep apnia, diabetes...). I did not have a full two years so I had to write a letter of sorts talking about my weight history and struggles to lose weight.

Started first week Oct, last session mid-January, got letter of approval in a week, surgery less than a month later.

So far my out of pocket has been $25 per visit, $35 for psych co-pay, and $100 when I checked into hospital. Based on EOB's that have come in I am expecting another 1300-2000 from hospital, anesthesiologist, and whatever else they come up with.


    hely88

    Bariatric Master

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Posted March 5, 2013 - 4:49 PM

#4
All I know is I have BCBS of Florida and they don't pay for any of my fills.


    destynee1

    Aspiring Evangelist

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Posted March 5, 2013 - 5:25 PM

#5
I had BCBS and I didn't need to do diet. I only needed 1 Nutritional visit and a history of my failures with dieting from my Dr.


    m1aman

    DoberGuy

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Posted March 5, 2013 - 5:28 PM

#6
I had to dance for three months and got approved in about 10 days.


    BigOBoy123

    Senior Member

  • Posts: 99
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  • Surgery: LAP-BAND
  • Surgery Date: Jun 2013
  • Starting Weight: 309 lbs
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  • Current Weight: 278 lbs
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  • BMI: 35.7
Posted March 6, 2013 - 3:29 AM

#7
Thanks guys. You all have been awesome. So far I have been to my first seminar with my surgeon and got the required paperwork to send back to them. I called my insurance provider BCBS and they said I had to show 3 months of prior weight loss documentation. I already have that so I should be good to go with everything else that is required. I am so ready to get this done, I hope I dont have to ait much longer. Can you guys tell me how long you were off work after your surgery? I am a Correctional Officer so my job is pretty physically demanding and do not want to risk getting ina fight and hurting myself due to the surgery. Thanks.


    Drummergirl

    Intermediate Member

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Posted March 6, 2013 - 4:27 AM

#8
I have BCBS & they did require it. It took them 2 years to approve me. They kept delaying for this or that.


    pinx

    Senior Member

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Posted March 6, 2013 - 4:54 PM

#9
BCBS - fed requires 3 months of supervised weight loss, a nutritional assessment from a certified nutritionist, a psych evaluation, plus meet all of the requirements to get the lapband (40+ BMI or 35+ BMI and comorbid conditions) and have tried to lose weight on your own multiple (not specified as far as I know) times and failed or gained it back. I am stuck at the psych eval, but otherwise am done. The superviser at the psych clinic is holding on to my eval after going on vacation despite my calls and my doctor's calls.

If you need any more information just let me know... I am going through the process myself and have called them many times and my doctor's office is great at keeping me in the loop with the process. I can even tell you what my copays have been so far.


    pinx

    Senior Member

  • Posts: 55
  • Joined: Feb 2013
  • Surgery: LAP-BAND
  • Surgery Date: Apr 2013
  • Starting Weight: 223 lbs
  • Weight Lost: 32 lbs
  • Current Weight: 191 lbs
  • Goal Weight: 130 lbs
  • BMI: 32.8
Posted March 6, 2013 - 4:56 PM

#10
BTW, the diets you have tried on your own and failed may be the 6 months of documentation. I am not sure on that, but I have done WW multiple times, went through my doctor's weight loss clinic, and tried various other diets. I didn't have to provide paperwork to show the diets I had tried. I just had to list them, the estimated dates, and how much I lost.



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