Anyone with BCBS of il? Do they require the three or six month diet for approval?

Thanks all :-)

zero - but whomever is managing your account might -

do you have *** or ppo and what group are you with...

i’m in purgatory right now - right in the middle and was told they won’t even let me see the surgeon until I meet the pre-requirements -

BCBS however told me day one - zero copay - zero deductable.

zero - but whomever is managing your account might -

do you have *** or ppo and what group are you with...

i’m in purgatory right now - right in the middle and was told they won’t even let me see the surgeon until I meet the pre-requirements -

BCBS however told me day one - zero copay - zero deductable.

I have PPO. I don't know what you mean when you ask group? Explain please and I will try to help as best as I can... So ur in the middle of the diet and they won't let you meet w the surgeon? I did all of the pre appts with the psych and he nutritionist and ketosis diet and my info was submitted to my primary insurance who denie it as I knew they would and now I am waiting approval from BCBS OF IL which seem to cover everything just wasn't sure about the diet because I have heard mixed info. :-(

I can’t even talk to the surgeon until I meet the 6 mo of supervision with monthly weigh in and nut visits

I am h mo and the rules are different -

Here are my requirements from my group - which is more stringent than my h mo

Clinical Indications for Bariatric Surgery

• Growth has been completed (18 years of age or documentation of completion of bone growth).
  
• Body mass index (BMI) exceeding 40 or body mass index of 35-39 with at least two of these comorbidities (hypertension, dyslipidemia, type 2 diabetes, coronary heart disease, sleep apnea).
  
• Medical documentation reveals the member has been morbidly obese for five years or more
  
• Medical documentation reveals the member has failed a medically-supervised program of weight reduction spanning at least 6 continuous months of documented monthly weigh-ins, occurring within the 12 months preceding the request. Such a program would be expected to consist of:
  
  • Documentation of nutritional therapy or medical nutrition therapy including a very low calorie diet (e.g. MediFast or OptiFast) unless contraindicated
    
  • Behavior modification or behavioral health interventions,
    
  • Supervised increase in activity
    
  • Pharmacologic therapy (unless contraindicated).
    
  • Maintenance support to continue to encourage nutrition choices to reduce health risk factors and maintain a healthy lifestyle.
    

  [*]The surgical program must document the absence of significant psychopathology that would hinder the ability of an individual to understand the procedure or to comply with medical/surgical recommendations, or that documents psychological readiness for the surgery.

  • Documentation of willingness to comply with preoperative and postoperative treatment plans
    
  • Evaluation by an independent licensed psychologist or psychiatrist unaffiliated with the bariatric center.
    

I can’t even talk to the surgeon until I meet the 6 mo of supervision with monthly weigh in and nut visits

I am h mo and the rules are different -

Here are my requirements from my group - which is more stringent than my h mo

Clinical Indications for Bariatric Surgery

[*]Growth has been completed (18 years of age or documentation of completion of bone growth).

[*]Body mass index (BMI) exceeding 40 or body mass index of 35-39 with at least two of these comorbidities (hypertension, dyslipidemia, type 2 diabetes, coronary heart disease, sleep apnea).

[*]Medical documentation reveals the member has been morbidly obese for five years or more

[*]Medical documentation reveals the member has failed a medically-supervised program of weight reduction spanning at least 6 continuous months of documented monthly weigh-ins, occurring within the 12 months preceding the request. Such a program would be expected to consist of:

[*]Documentation of nutritional therapy or medical nutrition therapy including a very low calorie diet (e.g. MediFast or OptiFast) unless contraindicated

[*]Behavior modification or behavioral health interventions,

[*]Supervised increase in activity

[*]Pharmacologic therapy (unless contraindicated).

[*]Maintenance support to continue to encourage nutrition choices to reduce health risk factors and maintain a healthy lifestyle.

[*]The surgical program must document the absence of significant psychopathology that would hinder the ability of an individual to understand the procedure or to comply with medical/surgical recommendations, or that documents psychological readiness for the surgery.

[*]Documentation of willingness to comply with preoperative and postoperative treatment plans

[*]Evaluation by an independent licensed psychologist or psychiatrist unaffiliated with the bariatric center.

Oh goodness! I wonder if it is like that with mine?! I didn't look into all of tw requirements. I know this sounds silly to be honest w u but I didn't realize I would have to do the diet etc. where did you find this info? For your benefits site?

Oh goodness! I wonder if it is like that with mine?! I didn't look into all of tw requirements. I know this sounds silly to be honest w u but I didn't realize I would have to do the diet etc. where did you find this info? For your benefits site?

Are you insured through your employer? If so, each employer may have different rules than another. I"m BCBS of AK but we own the company and make the rules (within the rules of our state of course). Many BCBS plans are like this. Your group number is basically a number they assign to your employer and it identifies your plan. If you just pay for BC on your own without an employer you would still have a group number on your card.

Are you insured through your employer? If so' date=' each employer may have different rules than another. I"m BCBS of AK but we own the company and make the rules (within the rules of our state of course). Many BCBS plans are like this. Your group number is basically a number they assign to your employer and it identifies your plan. If you just pay for BC on your own without an employer you would still have a group number on your card.[/quote']

Thanks iffy. What does the group number determine?

Iggy*

Thanks iffy. What does the group number determine?

LOL I'm iffy sometimes too....

Your group number tells BCBS what policy you are under. No different than if they had a policy a, b and c, they instead have policies with numbers. Mine is about five numbers listed on my card. When I call or go online I enter it or tell them that number so they can check my coverage for certain things (ie this surgery which mine did not cover). There are hundreds of variations of BCBS in just one big city, let alone a state. So you really have to know YOUR coverage, not just a general coverage by BCBS of your state...that won't answer your questions.

Iggy is right--there can be hundreds of different policies within BCBS. I have BCBSIL & work for them as well. I didn't have to do a diet but did get a psych & gastroenterologist clearance. Yours may vary.

Suggest you call customer service (#is on the back of your card) to find out what you have for benefits & coverage.

Iggy is right--there can be hundreds of different policies within BCBS. I have BCBSIL & work for them as well. I didn't have to do a diet but did get a psych & gastroenterologist clearance. Yours may vary.

Suggest you call customer service (#is on the back of your card) to find out what you have for benefits & coverage.

Thanks needa sleeve and iggy! I called and they said it was covered but I didn't ask what the requirements were as far as diet, weight history, etc! So I called again and he said it varies. And this was my customer service number also. So I figured id give it a shot on here, as there are so many veterans. :-)

I have done the psych eval, the nutritionist visit, and the ketosis diet and now I'm just waiting to hear back from the insurance. :-(

Thanks needa sleeve and iggy! I called and they said it was covered but I didn't ask what the requirements were as far as diet' date=' weight history, etc! So I called again and he said it varies. And this was my customer service number also. So I figured id give it a shot on here, as there are so many veterans. :-)

I have done the psych eval, the nutritionist visit, and the ketosis diet and now I'm just waiting to hear back from the insurance. :-([/quote']

It varies...duh dude that's why I called! Ask for a supervisor and get the details from them (along with name). Geeze, if one of our people got an "it varies" our agent's heads would be rolling!

The other place to call is your personnel office. They have someone there who knows the entire answer you seek. (I sound like yoda there).

It varies...duh dude that's why I called! Ask for a supervisor and get the details from them (along with name). Geeze' date=' if one of our people got an "it varies" our agent's heads would be rolling!

The other place to call is your personnel office. They have someone there who knows the entire answer you seek. (I sound like yoda there).[/quote']

Lol iggy. I know I hear you. He said if any further info is needed they will let you know. Like ok?! I'm impatient. But you know how insurance companies are :-(

Actually, why isn't your surgeon's office helping you out here? It is the surgeon that is wanting to get paid too...just saying.

Call... Ask they will tell you exactly Shari's required. When I was going thru the process it was 6 months, but I think it changed.

Mine is covered by bcbs BUT the group that manages my benefits (dupage medical) has these requirements before I can even see the surgeons office - they are very strong in this