Hi All. I started the process in January of getting everything together for gastric sleeve surgery. The surgeons office have me a list of things I needed to do I.e. X-rays, blood tests, psych Eval, EKG, visits with dietician, etc. I was told I needed to see the dietician until she thought I was ready and needed to lose 15 lbs. I saw her in feb, march, had to reschedule April and may and saw her again in June and July at which time she signed me off.

Finally 2 weeks ago I had my sleep apnea study complete and all was sent to insurance.

I got denied because I didn't have "6 consecutive months of medically supervised weight loss program"!!! NOBODY told me I needed that. I even called my insurance back in January and all they said was it would be coveted if deemed medically necessary by physicians.

I'm so upset. If I had known it had to be consecutive of course I would have gone every month! I kept a food diary and everything but had no idea it had to be 6 months.

Any advice?? Do you think they will actually make me start over with 6 more months??

My BMI is 46, I have type 2 diabetes, high blood pressure, moderate sleep apnea, and I'm only 32. I am so ready for this surgery and I just keep crying because this seems so unfair. Nobody told me this throughout this whole process

Help !

I am so sorry. I am so surprised that someone didn't verify that for you. My surgeons office recommended I keep going, even after approval, up to my surgery just in case something happened. I hope it can work out for you.

I am so sorry this happened to you. I would call your insurance company and ask for a written copy of their requirements. I know bc/bs for my plan had eliminated the 6 month diet requirement. Perhaps there was an error. I would make sure you get in writing the defination of 6month supervised diet. Then see if you can use some of the time you worked with the dietitcian toward that 6 months. I am so sorry the surgeon's office dropped the ball for you. I wish there was a way for them to "fix" their mistake.

I'm sorry this happened to you. I have question. are you seeing your doctor or the nutrionist? I work for insurance company and just want to make sure your seeing your primary doctor for six consecutive months.

I'm sorry this happened to you. I have question. are you seeing your doctor or the nutrionist? I work for insurance company and just want to make sure your seeing your primary doctor for six consecutive months.

I was seeing the nutritionist. The insurance company never told me I had to see a pcp for 6 consecutive months and I called them and asked if I was covered and what was needed

They are not going to approve without the six months from your primary doctor. Don't get discouraged. The 6 months will go by really quickly. Trust that it is for best that surgeons office didn't proceed. Bcbs has been going back requesting chart reviews on patients 2 yrs after procedure and when required documentation is not there, member is billed and they take money back from surgeon. Schedule appt with your doctors office today for this month. Lets get started

Also make sure to schedule 2 Drs. Appointments per month to ensure that if you miss one/they cancel you still make appointment for that month. I had 3 appts scheduled per month to ensure I was covered. My doctors office is horrible and has tendency to cancel and reschedule you for the next month. Nope not me.

They are not going to approve without the six months from your primary doctor. Don't get discouraged. The 6 months will go by really quickly. Trust that it is for best that surgeons office didn't proceed. Bcbs has been going back requesting chart reviews on patients 2 yrs after procedure and when required documentation is not there' date=' member is billed and they take money back from surgeon. Schedule appt with your doctors office today for this month. Lets get started[/quote']

I also have Blue Shield but I went through my PCP. she scheduled tests ect.. And documented problems then requested I be seen by a surgeon to assess options. I talked with the surgeon, he had my records and I was approved in72 hours. May e you should go back to your PCP and ask her to help you get approval? Hope it works out. If it doesn't remember you have waited years to change your life, you can do 6 months. Develop a plan for how you will manage this time. Make better meals, stop soda, ditch fast food or whatever so that when you have your surgery you will be set up for success! Best of luck

Thank god someone else is going through the same crap I am. I have been working on this since December. I went to my info session, first appt with dr and was given my surgery date, about to go do the psych eval and the dr office called me, the insurance excluded bariatric. Now I'm pissed, I called the insurance company 3x prior to info session and no one told me it was excluded. I got ahold of benefits coordinator at my husbands job to get more info. I found out that the union will open up the benefit as long as I submit an appeal with all the criteria. The 6 months diet, all my paperwork, etc. I collected everything and sent it in a binder with tabs... And... They denied me. I need 6 consecutive months with the bariatric team NOT my regular doctor, and the psych eval. Well they never told me that! So now I have to do the ENTIRE program, SELF PAY. Then submit everything again. And they MAY approve me to open the benefit to pay for the surgery and hospital stay ONLY!!! Ahhhhhh! Soooo want to scream! Sorry so lengthy, needed to vent!

Which bcbs plan do you ladies have

Same thing here. My insurance will not cover anything weight loss related. I have high blood pressure, high cholesterol, diabetes, anxiety, sleep apnea and degenerative disk disease and asthma. They pay for all the medications and all the surgeriies I've had due to being morbidly obese but they won't pay to help fix the cause of the problem. I researched surery in Mexico and that is the route I have decided to go. Surgery is 9/13 and I am so ready to be healthy.

I have BCBS as well and have been told I need 4 months of supervised dieting. Yet my wife's cousin was approved immediately by BCBS and had her surgery within two weeks. Different groups different requirements I guess.

I also have BCBS, I guess every "branch" is different. Plus my husbands union benefit fund is in control of the insurance and what they provide. So from visit one, until the surgeons office feels I am ready for surgery will be cash out of my pocket. Just feel like I've lost the last 8 months. And now have to start over because of the 6 months thing. So annoying! Just want to be pain free and play with my 1 year old without being short of breath! So what happens if we actually do well during this 6 months diet and lose say 20 lbs, and now I'm no longer in the BMI range? Then what? They won't cover it because I did so well? Anyone have this happen?

My insurance pre-authorized my surgery and confirmed my medical need, but when it came time to pay the bill decided that I hadn't gotten authorization for the hospital stay and only paid 50% rather than 90%. I have been fighting with them for 3 months, and can't get a straight answer out of them. The difference is huge! I owe over $9,000 right now and I should be paying only $2,000. Insurance in this country is arbitrary and the "for profit" aspect is contra to what is best for the patients.

This all just seems like bullshit and bad faith. I called and asked what I needed and if surgery was covered and nowhere did I get any info from bcbs that I needed this. Am I supposed to just guess??? The surgeons office gave me requirements and I met all of them. This just seems ludicrous to me.

Just hang in there. Everything will work out and your time will come. My primary gave me the run around for three months after he wrote my letter of support. He would not release my medical records. I continued to go to his office weekly, wrote letters requesting my records and paid additional office visit copays. It was nightmare and I thought I was going to need to find new Dr and start diet documentation all over. Finally on 8/27y Bcbs had to intervene to get my medical records released to the surgeon. He complied and sent to surgeon the very next day. I am now waiting on surgery date. So I would suggest that you request in writing for utilization review at bcbs the requirements. You have vented and now its time to move forward. Stay on top of everything. Schedule appointments with your primary and the dietian for this month and get started. Your goal is to have all 6 visits finished by first week of Feb.