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BCBS NC 6 Month Supervised Diet Maybe Changing as of July 1, 2014

During my bariatric appt today I learned that the 6 month supervised diet may be no longer after July 1, 2014 for BCBS NC policy holders. The Bariatric Association has been arguing that the 6 month supervised diet requirement has shown no benefit for many individuals seeking insurance approval and it prolongs on-going medical issues of many.

As we all know some individuals benefit from having to wait 6 months before surgery (more education, planning, etc.). However some individuals are dangerously obese and want to start their journey to becoming healthier.

I did not want to wait, I've been educating myself over the past 3 months (everyday) because I'm ready for a change. I've always been overweight. I have 2 pages of past diets and I can't count how many times I've tried to starve myself so I wouldn't put calories in my body (hoping my body would burn the fat). I know some may say that was stupid, it was but I've always wanted to look healthier. I have a very nonexistent metabolism. I have to work out 7 days a week, 30 days a month to see results. Realistically I don't have the time with career, 3 children, husband and household.

I learned this morning that I only have to complete my endoscopy and psychological. Then I can see my surgeon and get scheduled for surgery!!

Anyway I didn't mean to get off topic but I'm really excited :)!! I will definitely keep you posted if i hear more regarding BSBC NC decision. Hope this helps someone.

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  • mentalistfan
    mentalistfan

    The BCBS of IL already did away with the six month supervised diet but a lot of surgeons and patients aren't aware of it...I got a copy of my policy and sent it to my insurance coordinator at the surg

  • beachgurl84
    beachgurl84

    I've been watching the BCBS website all day for policy changes. While they have listed some, they haven't listed anything about this surgery. BUT....they also haven't updated the corporate medical p

  • Danalodon0825
    Danalodon0825

    Hey everyone, just called my surgical practice for update. They've heard the following, the decision to eliminate the 6 month supervised diet has been approved. However practices cannot do anything di

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I have BCBS CA (though I'm in a different state) and my pan doesn't require the 6mo supervised diet either, as far as I can tell. I did call to clarify but they were about as clear as mud. My surgeons office called and the only requirement was a psych evaluation and past weight loss attempts. Just did the evaluation and hoping that means we'll submit for approval by August.

Hi Lexibelle,

I did a quick search for you just like I did for our policy. I googled "BCBS CA Corporate Medical Policy". I found the BCBS CA list of medical policies that have requirements before approval. Here is the link:

https://www.blueshieldca.com/provider/authorizations/clinical-policies/medical-procedures/policy.sp

Where as NC list it as "Surgery for Morbid Obesity," CA list it as "Bariatric Surgery." PLEASE DOUBLE CHECK your plan because from what I see, your plan does require 6 months (pg 3) . I'm sorry, I'm not trying to get in your business or anything. I just know I had one heck of a time sorting out the "mud" in the NC policy and if someone had pointed me in the right direction I would have been grateful. Good luck to you and please let us know what you find :)

Thanks, though I guess mine is technically Anthem now that I look at my website. These are my requirements: http://www.anthem.com/medicalpolicies/policies/mp_pw_a053317.htm

I contacted them because of the 'proof of past weight loss attempts' and how vague it was. That's what they were about as clear as mud about. I basically got told, well - we won't know exactly what you'll need until it goes to the review board. Blah!

I'm thinking positive and hoping that my weight + multiple co-morbidities + surgeon's analysis of my past attempts will be enough to satisfy them.

  • 2 weeks later...

<p>I have BCBS Highmark (live in PA) anyone have that insurance?</p>

I have bcbsnc but I'm having my surgery in PA. My surgeon's office specifically mentioned high mark having the 6 mo requirement and being difficult about approval. I don't know why, that's all they said.

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