BCBS Federal - NUT not needed?

beachlover09 · August 8, 2011

My surgeon's office is saying that nutrition counseling is not required by my insurance as long as I have had my three month supervised diet. She said the only thing required is two year weight history, three month supervised diet, psych evaluation, and a letter from PCP saying medically necessary. Did anyone else that has BCBS Federal not have to see a nut and still got approved?

LR6909 · August 8, 2011

I have Empire BCBS and had to see nutritionist. My doctor's office has one on staff. Even if I didn't, they probably would want me to see her just to get the "instructions" on how and what to eat.

ScaleWarfare · August 8, 2011

I have Federal BCBS and was required to do a three month medically supervised diet. Here is the link to the plan book for Fep BCBS insurance. The information about bariatric surgery is on page 56-57

http://www.opm.gov/insure/health/planinfo/2011/brochures/71-005.pdf

Hope that helps!

beachlover09 · August 8, 2011

I have Federal BCBS and was required to do a three month medically supervised diet. Here is the link to the plan book for Fep BCBS insurance. The information about bariatric surgery is on page 56-57

http://www.opm.gov/i...ures/71-005.pdf

Hope that helps!

Thanks so much. I looked and looked for that info. I appreciate the page number! From what I read, it says that you need a three month supervised diet, as well as nutrition counseling. My three month supervised diet is with my PCP. So, I am thinking I will need to see a nutrionist also. I have an appointment scheduled with a nutrionist on Wednesday, but it is two hours away and a $75 copay. I am thinking I should just do it. It won't be for nothing if I don't need it......at least I will learn something. Did you do a supervised diet and also meet with a nutritionist?

ScaleWarfare · August 8, 2011

My supervised diet was with a nutritionist, so I was covered for both. The first appointment that I had was one on one with a nutritionist, the other appointments were in a group class with a nutritionist. My surgeons office has the supervised diets pre-organized for us if we want to participate in the ones that they offer. I figured that was easiest They know what the insurance companies require for the most part.

I'm not sure where you are located, but one of the biggest things I've learned with Federal BCBS is that it matters who your plan administrator is. BCBS Federal is the over seer of the plan, but they contract out to the various BCBS administrators, and that is who actually takes care of the approval process. For example, here in the DC area, if you are in MD or DC your administrator is Care First I believe, but in Northern VA where I am, my administrator is Anthem.

beachlover09 · August 8, 2011

My supervised diet was with a nutritionist, so I was covered for both. The first appointment that I had was one on one with a nutritionist, the other appointments were in a group class with a nutritionist. My surgeons office has the supervised diets pre-organized for us if we want to participate in the ones that they offer. I figured that was easiest They know what the insurance companies require for the most part.

I'm not sure where you are located, but one of the biggest things I've learned with Federal BCBS is that it matters who your plan administrator is. BCBS Federal is the over seer of the plan, but they contract out to the various BCBS administrators, and that is who actually takes care of the approval process. For example, here in the DC area, if you are in MD or DC your administrator is Care First I believe, but in Northern VA where I am, my administrator is Anthem.

I am located in Oklahoma, but I will be having the surgery in Texas. I think I should go to the nutritionist, better safe than sorry. Thanks for your help. I really appreciate it.

firefighter2621 · August 21, 2011

My wife and I are both having the Gastric Sleeve. We have Empire Blue Cross/Blue Shield. Recently(within the last month or so) they changed their policy again. At one time it was required to do 6 months of doctor supervised weight loss. Then they changed it to 3 months. Now the new policy states that as long as your BMI is 40 or greater of you have other surcumstances such as sleep apnea or high blood pressure, you no longer have to have a doctor supervised diet plan. Both of us went in 2 and a half weeks ago and we are to have the surgery at the end of September/ early October. All we have to pay out of pocket for is $250.00 per person for a class that they require us take, and $250.00 per person for hospital charges. We will both have the procedure for $1000.00 out of pocket. I cant say how all of Blue Cross/Blue Shield is, but we have had no problems with Empire.

August 22, 2011

Call your insurance company and speak directly to a case manager. They will tell you exactly what you need for approval! That will take the guess work out of it.

I have Cigna and my docs insurance person was telling me I need more than the case manager told me I needed for approval. I wrote down what the case manager said. Sometimes, docs offices deal with so many insurance companies, they mix up what company needs what. My docs office was telling me I needed a 5 year weight history which would have been impossible for me to get! Also, it is even more confusing now that insurance plans have "high" and "low" options. This is why you should get it directly from the source.