Jerseygirl4523

I have a bcbs and they required 6 months medically supervised diet before they will approve. My initial surgical consult was November 20. I had my final appointment today and they are submitting it to Insurance tomorrow. I had a $2000 deductible with my insurance and a $3,000 out of pocket max. I hit the out of pocket max during pre op with the appointments and tests so my surgery will not be costing me anything

My surgeon’s office is submitting my claim to BCBS April 5!

Definitely a great idea! My Bariatric surgeon, gyno and pcp are in same hospital network. My gyno referred me and my primary has been very supportive. He’s even excited for me! He’s hoping to learn from my experience because he has other patients he thinks the Bariatric clinic could really help.

I finally got confirmation today that my surgeon’s office will send everything to insurance after my last 6month diet appointment April 5. It is crazy to think I could be scheduling my surgery 3 weeks from now

I had the same question. My surgeon’s Office say they go by your starting weight at your initial appointment. I’ve had similar problems when calling Anthem to try and get an answer. Try the nurse hotline, they seem more helpful

I am very close to getting approved for surgery and I’ve felt more urges to act out or slip up in my diet. Not take in enough water or eat things I shouldn’t. Has anyone else struggled with this?

Unfortunately the last week it’s has been my pathway coordinator with my surgeon’s office who has been difficult to track down! My 6th appointment is April 5, so I’m eager to get an answer and submit to insurance.

Was it just 6 monthly appointments?

I also have anthem. My surgeon has a rule you cannot gain during the process, but by that they mean you cannot be heavier than the day you started the process (first consult). I have 1 month left!! Did you do 6 appointments in 6 months or did it have to be a min of 180 days?

Did you have to do 6 appointments in 6 months or actually wait 180 days?

How long did approval take? Did you have to do 6 appointments in 6 months or actually a 180 period?

I have anthem. What was your requirements for the 6 months? I’m using my primary and we’ve had an appointment every month. But iceberg heard some say it actually has to be at least 180 days. What did you need? Just 6 appointments in 6 months?

I have anthem bcbs which requires 6 months. I’ve heard that some insurance companies actually need it to be at least 180 days. Is that true? I also have PCOS, that’s why I am getting surgery. Can’t wait to feel normal for once

They are covered as normal visits and tests that a doctor has deemed necessary. The surgeon’s office will submit to insurance for pre approval of surgery when all of the items that heir office and your insurance requires are completed.

Why did you pay out of pocket, are they in network? I have Anthem BCBS and they have paid for everything. I still had to meet my out of pocket max first of course. My surgeon’s office was able to get the nutritionist and exercise consults covered. My endoscopy ended up costing me maybe $1200 because I hadn’t met my deductible yet. It’s been a smooth process so far. just waiting on this 6 month rule... anyone know if it actually has to be 180 days?

I have anthem in North Carolina. How long did it take for your approval?

Soooo I have Anthem BCBS and their policy is similar. They do not cover diet or exercise programs. However, when the Bariatric center I am using billed my insurance for my nutritionist appointment, it was completely covered. These places know what they are doing. I was also able to use my primary for my 6 month requirement which is always covered as a normal office visit. They just need to make notes that you discussed surgery, diet and exercise and weight loss.

I had to have a sleep study because both my parents have sleep apnea and my doctor wants to make sure that if I do have it, it’s controlled bore surgery. I got my results Friday and it was completely normal. There’s other comorbidities that may apply. If they have find GERD during your endoscopy (like me), or something in your blood work comes back abnormal, high blood pressure, gallstones, the list goes on. Bariatric centers can help you find a comorbidity.

Interesting, I’ve heard of that before, but not for surgeons. The office I use is friendly, but getting them on the phone is a hassle. They pick up, but the person they transfer you to might not lol. I’ve been trying to track down my pathway coordinator to verify what remaining requirements I need and I haven’t gotten a call back yet.

I finally got access to the patient portal the bariatric clinic uses, outside of mychart, yesterday. It’s where they keep your checklist online. I got nervous because it said “medically supervised diet program (6 consecutive months covering 180 days min.)” I’m know that could be an auto populated choice and not what my individual insurance actually requires.

It’s been a while since this topic has come up.. but I have some concerns as a near the end of my insurance requirements. I have anthem bcbs and I am required to do the 6 month medically supervised weight loss. Is that 6 months with just 6 appointments or does it truly have to span a minimum of 180 days? My surgeon’s office was able to confirm that this is the last requirement I need to complete. However, I have not had a chance to ask them about the technicalities yet.

How did they take you on as a patient if you haven’t met him yet??

THey go by your initial weight at your first surgical consult!!!!

how long did it take for you? I have anthem and i am supposed to finish my 6 months up in a couple weeks. Otherwise, i'm all ready to submit

I know exactly what you’re talking about. It might be called the Big Ward. It’s in New Zealand and all regular people trying to qualify for surgery. I also binge watched the whole thing lol