KittyChick

Um...guess you can't type H M O on this board or they'll *** it out

Thank you all for your responses.

I went to the initial 2 hour group seminar with the bariatric surgeon at the hospital and they did give me a huge packet afterward. When they asked for the ins info, I told them I currently have an *** that doesn't cover weight loss surgeries and would have BCBS on January 1st. They wouldn't make an appt. with me until Jan, so my PCP and I have decided to get a 3 month jump on the 6 month requirement so I could seek approval by March. My PCP wanted some specifics on format/documentation but it looks like I'll have to wait to see the surgery center in Jan?

Hi all,

I new to the community and need help on the proper paperwork to send to BCBS of CA PPO (or any other provider who requires these things specifically.)

They require:

History and physical w/prior weight loss attempts

Non surgical weight reduction program (PCP supervised, inital and end weight, duration with start and end dates.

Description of exercise program and duration or medical contraindication to an exercise program

Monthly documentation of weight over 6 consecutive months (medical records and/or weight loss logs)

Monthly documentation of dietary regimen, physical exercise, and behavior modification for 6 consecutive months (medical records and/or weight loss logs)

Nutritional consultation

Psychological consultation showing patient cleared for surgery

Medical doctor order for surgery that inclues weight, height, BMI, surgery requested and recommendation

The nutional consult and psych consult will be done by the hospital's bariatric surgery dept. so I'm not worried about those. It's the REST of this stuff that I'm concerned with. My PCP doesn't have a lot of experience with these requests and we need to make sure the documentation is PRECISE so I will be approved right out of the gate.

Is anyone willing to share with me the documentation submitted to your ins co? You can email it to me and black out any personal info and weigh in specifics. I just need the format in which we should submit this cause we need to know how everything should look. If anyone would be so kind as to do this for me, I will be profoundly grateful.

For the folks who needed co-morbities for approval - who was your ins co?