Requirements for WLS?

[snowkitten 371]

I finally got my first appointment for eval with the surgeon scheduled for 4/30. The staff was great and already called the insurance company to make sure the procedure was covered (not the same as being approved). My insurance gave them my list of documentation needed for approval but it seems very vague. I have Federal BCBS and one of the requirements is a...

"Participation in a medically supervised weight loss program, including nutritional counseling, for at least 3 months prior to the date of surgery." Has anyone had to fulfill this requirement?"

What exactly does that MEAN? Would going to my doctor for weight problems and seeing the on staff nutritionist count? And how do I OBTAIN that knowledge as documentation? Would I have to request my medical records, or could i just get my primary care dr to write a statement that it has been done?

[Scylla 106]

Hi there. I am scheduled to be sleeved next Wednesday (!) My insurance company required SIX months of medically supervised weight loss sessions (which was actually seven months because they don't count the initial visit). I could have either met monthly with my primary care doctor or the bariatric nurse at my surgeon's practice. I met with her, and I'm glad I did because my doctor would probably just have weighed me each month. The bariatric nurse actually had me making goals each month for changing my lifestyle and eating habits prior to surgery.

Hope this helps!

[southern_sweetie 21]

I also have BCBS Federal. I have to do the 3 month supervised weight loss program with my PCP. But Scylla was right, it is 4 visits due to the initial visit. I also had to have 2 years of medical records showing my weight, a psych. evaluation, medical clearance from my doctor, a seminar, a support group, and a visit with the NUT and my surgeon. I am in the beginning stages myself.

Edited April 16, 2014 by southern_sweetie

[Miss Mac 6,261]

I am a retired federal employee still carrying BCBS Federal. My primary physician provided me with a print-out of the past two years of office notes, and I highlighted my weight for each visit, along with with any comments or recommendations from the doctor. The bariatric center took me through a three month program which included a monthly nutrition visit and bariatric physician visits, two visits with the psychologist, and two with the surgeon. There was also a cardiac clearance, a liver ultrasound, and EKG, and upper endoscopy.

I also included a personal letter explaining how my co-morbidities were affecting my quality of life and how the surgery would give me a powerful tool for improving my health outcomes and lifespan. When the final packet was submitted, it was approved in two days. My BMI was 40.6, but BCBS Federal will approve a BMI of 35+ if yo have multiple co-morbidities.

[walkingshammy 1]

I had to do a 3 monthly weigh ins at the center, psych eval, sleep study, ekg, stress test, psch eval and see a nutritionist

[snowkitten 371]

Thank you all for your reply, it helps tremendously!! I have a funny feeling what my doctor has documented wont be "enough". Ive been going to the doctor for years with weight concerns and have seen numerous dieticians BUT i dont trust that they documented it to the standard requried. Wow, that sounds paranoid. Im a med coder (for the facility i see in fact) and have seen my records so i know that they havnt been documented correctly. It sounds like i will have to be a little more proactive. From what im hearing regular weigh ins will qualify tho? So then what i really have to do is get all my med records sent to me. Ugh... that could take awhile.

Thank you miss mac for the idea of a personal letter. I didn't know that was something that could be done. Great idea!