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 !

It's not the insurance company's fault. And no, I do not work for one.

WE are responsible for knowing the requirements. Your employer decides what is covered and what is not covered along with how long you must wait pre-op. They pick which package they want to pay for. The insurance company is simply following the guidelines that that are set out by the company who is providing the benefit.

Some BCBS plans have no wait, some have 3 months (mine), some 6 (my last company), some a year (our county schools), some 2 years (the neighboring county schools) and some have no coverage at all (my BFFs). We are all BCBS.

I just got off the phone with the union, and they said that I can do my 6 months with the PCP, but it must be consecutive! I didn't have consecutive before. And then I would need my psych eval, which is $500 btw. Then resubmit.

Now if I do the requirements for the insurance I'm ready to go. BUT then what about the bariatric program requirements. Would I need to satisfy that also?

Guess I need to make some more phone calls.

My surgeons program didn't have any additional requirements for me to follow. I believe that depends on individual and your medical status. Follow up with your baratric program coordinator to determine what else outside of the insurance requirements is the surgeron requiring from you. i know some people have been required by their surgeron to loss x amount of weight before they will perform the procedure

I didn't see the doctor every month, but I was MEDICALLY supervised by the dietician every month, and the surgeon's office met to go over the case files at least monthly. So there may be room in that respect, as long as it's CONSECUTIVE months. I know they're a real stickler on the consecutive visits.

We checked our package and read through the entire guidelines and it says nothing about bariatric surgery. Yes, I vented, and with good reason. I do blame insurance companies. They are misleading and do whatever they can to weasel out of actually paying for anything. I lost 15 lbs under a diet set forth by my nutritionist. I say that's more telling than 6 months consecutive.

It's arbitrary and trite and bs.

Ok now I'm done venting. I have a dietician appt next week and still waiting on pcp appt. Shes very hard to get appts with.

I was required by the surgeons office to have blood tests, 2 x-rays, an EKG, sleep study, psych Eval, dietician appts and lose 15 lbs, all of which I completed.

The medical policy that the insurance companies use isnt misleading. for bcbsm of mi the policy clearly states 6 consecutive months uder dr supervised care. A dietitian is not a medical doctor.. They only monitor your food intake. Whereas a medical Dr. Also sends you to other specialists like cardiology to ensure enverything is ok. Your going to need cardic clearance and surgeon doesn't refer you for that

When was last time you saw Dr.

Today I finally received the date of my first appointment. Included in the email were the insurance requirements. They are listed below. I'm not sure how I'm going to go about providing evidence of failed weight loss attempts. I've never done WW or any other type of supervised weight loss. I've always lost weight (and gained it back) on my own. Or will the medically supervised program I'm about to start satisfy that requirement? Any advice?

Blue Cross Blue Shield Insurance- Federal Surgical Weight Loss Requirements

-​BMI ≥ 40 or BMI ≥ 35 with co-morbidities who has failed conservative treatment.

-Participation in a medically supervised weight loss program, including nutritional counseling, for at least 3 months prior to the date of surgery.

-Evidence that attempts at weight loss in the 1 year period prior to surgery has been ineffective.

- Psychological Evaluation

-Patient has not smoked in the 6 months prior to surgery

-Patient has not been treated for substance abuse for 1 year prior to surgery

- Two years of obesity history

I filled out weight watchers food journals and turned those in to show previous weight loss attempts. Also I work for Bcbs and they paid for my weight watchers as well as my medical weight loss. We pay out of pocket and submit for reimburstment aspart of our yearly employee allottment for healthy living. Let me do some research tomorrow with couple of friends who had procedure to see what they used

All I had to do was write a list of all the things I've tried. WWs, Atkins, South Beach, Phentermine, doctor supervised, nutritionist. No actual documentation was submitted, but just a estimate of time frames and outcomes of each.

Today I finally received the date of my first appointment. Included in the email were the insurance requirements. They are listed below. I'm not sure how I'm going to go about providing evidence of failed weight loss attempts. I've never done WW or any other type of supervised weight loss. I've always lost weight (and gained it back) on my own. Or will the medically supervised program I'm about to start satisfy that requirement? Any advice?

Blue Cross Blue Shield Insurance- Federal Surgical Weight Loss Requirements

-​BMI ≥ 40 or BMI ≥ 35 with co-morbidities who has failed conservative treatment.

-Participation in a medically supervised weight loss program' date=' including nutritional counseling, for at least 3 months prior to the date of surgery.

-Evidence that attempts at weight loss in the 1 year period prior to surgery has been ineffective.

- Psychological Evaluation

-Patient has not smoked in the 6 months prior to surgery

-Patient has not been treated for substance abuse for 1 year prior to surgery

- Two years of obesity history[/quote']

For the three months, they don't specify nutritional counseling with a nutritionist. Seems like nutritional counseling with your dr would suffice, as long as its documented in your chart by your dr. And I would see the dr at least once a month in those three months just to be safe. From experience (six month insurance requirement), any work you do to prepare for the new way of living will pay off for you in the end.

Can someone please tell me where I was supposed to find the 6 month requirement. I just looked over my entire summary of plan benefits and coverages of which it only says bariatric surgery is covered but for more info check plan document and policy. Read the entire evidence of coverage/policy and not a word about bariatric surgery. When I called, the info was not given to me. So can someone please tell me how this is my fault and not insurance? How did you all find out?

Can someone please tell me where I was supposed to find the 6 month requirement. I just looked over my entire summary of plan benefits and coverages of which it only says bariatric surgery is covered but for more info check plan document and policy. Read the entire evidence of coverage/policy and not a word about bariatric surgery. When I called' date=' the info was not given to me. So can someone please tell me how this is my fault and not insurance? How did you all find out?[/quote']

Mine was not in the benefits book provided by my employer. It was on the insurances website under "Medical Policies." Member services should be able to read it to you, tell you where to find it and how to access it. If not, they are not doing their job.

Nobody in member services ever told me that. Im on the website right now for the insurance provider as well as 3rd party HR service that coordinates the insurance and nothing about guidelines. Maybe I'm missing it but if its this hard to find, that's sounding very unfair to me. I'm logged into our website and looking at everything related to our exact plan.