I set up my consultation today to get the ball rolling, so I called my insurance (blue cross Alabama) and they told me there were "no restrictions" against this procedure, and that the surgeon must state that this is "medically necessary" to get it approved. What about the "6 month period" I'm seeing people talk about?

Every insurance company has its own rules. Nuts huh?

My employer is self-insured and the insurance company is just the administrator of my employers rules. I had no 6 month waiting period. I had to use a network provider (80% coverage) or a Center of Excellence (100% coverage). The other requirement was a BMI of 40 for 5 consectutive years. That was my medical necessity. It wasn't written, but my surgeon's office knew they could qualify me with two comorbities (diabetes or sleep apnea, or hypertension) and a BMI of 35. Your selection of surgeon is important but so is a staff that knows how to work the rules.

My employer is self-insured and the insurance company is just the administrator of my employers rules. I had no 6 month waiting period. I had to use a network provider (80% coverage) or a Center of Excellence (100% coverage). The other requirement was a BMI of 40 for 5 consectutive years. That was my medical necessity. It wasn't written' date=' but my surgeon's office knew they could qualify me with two comorbities (diabetes or sleep apnea, or hypertension) and a BMI of 35. Your selection of surgeon is important but so is a staff that knows how to work the rules.[/quote']

Did you get approved using bmi of 35 and co-morbidities instead of having bmi of 40 for last 5 years?

Anyone know if PCOS and Insulin Resistance qualifies as comorbidities?

I was approved with a combination. My BMI was 40 for 4 out of the 5 yrs. Since I had both hypertension and sleep apnea, they allowed the one down year.

I have the same insurance and have to have a 6 month supervised diet you can read more https://www.bcbsal.o...s/final/053.pdf

3. Documentation must be present of participation in medically supervised weight loss program. For purposes of coverage, we (BCBS) recognize medical supervision of the diet and activity program by practicing MD's who are not bariatric surgeons, such as family practitioners, internists, and other primary care specialties (medically supervised weight loss or activity programs generally are not a covered benefit). Documentation provided by these health care providers will be recognized in the review process. At least one attempt must occur during the one year prior to request for surgery or date of surgery. Documentation must support participation in the program for six consecutive months. The following criteria must be met for this participation:

 Documentation of participation in a physician supervised program of nutrition and increased physical activity (including dietitian consultation, low calorie diet, increased physical activity and behavioral modification). Documentation of program participation must appear in the medical record no less than monthly for a period of 6 consecutive months by the attending physician. Documentation should include comments by the physician regarding patient progress or lack of progress. A letter does not meet this requirement. There must be medical records to document medically supervised weight loss attempts;

OR

Medical record documentation of a 6 consecutive month, nutrition-led weight loss program (Weight Watchers, LA Weight Loss, Jenny Craig, EatRight, etc.) with a minimum of 3 physician visits during that 6 month period documenting medical supervision, Not acceptable are self-directed programs such as joining a gym, Atkins’

thanks! since i posted i have seen my family dr. and told him what i wanted done. he told me to write a letter stating all of my previous attempts at weight loss (with failures and successes) and the fact that I take Metformin, and he would submit this to my insurance company. He got my BMI and told me I needed to come in once a month for 6 months for BMI check (he gave me a diabetic diet to follow). I also went to bariatric surgeons ofc and had a metabolic cart test done, and will have next appt with surgeon and dietician feb 22nd for the H Pylori test. I am just terrified of spending all this out of pocket at surgeons office ($550!) and being rejected by the insurance! My BMI is under 40 but the comorbidity im going with is having to take Metformin for my Insulin resistance. Say a prayer for me that all goes through smoothly!