Insurance Preauthorization

lafsalot · June 27, 2007

I'm just getting started with my pre approval and I'm getting worried. I have 2 physicians and a physician's assistant who will support my decision to be banded. However, my insurance (BCBS) wants 12 months of previously supervised weightloss management. I wasn't sure how strict they were going to be on this until a recent phone conversation. I think they are going to hold me to it. I don't want to wait another year!!! Has anyone found a way around this??? I mean, I've been on every program available - all to no avail, and none in the last 12 months.:help: ANY advice would sure be appreciated.

babs0101 · June 27, 2007

Hi Lafsalot and welcome! I too have to do a year of supervised diet by a physician. It sucks cuz I just started my journey too! I have Health New England for insurance and it is required. I will watch this thread just in case there is a way around it, but I haven't found one yet!

faithmd · June 27, 2007

Sorry, if it is in the contract in writing that it must be a 12 month supervised program of weight loss, then that's it.

I had to do it, my insurance required a 12 month MD supervised weight loss program and I had to have a 5% loss of my excess weight in that 12 months. The loss is to show your committment to the change. In my case, the 5% loss would have totalled 9 lbs. They also required me to visit MONTHLY and maintain regular attendance, miss a month and the clock starts over! In that year I had another health crisis, and ended up actually gaining 17lbs on top of the 9lbs I needed to lose (they don't look at your highest weight, they look at the weight your doctor records when you start the clock on the 12 months). I then started to lose some before my 12th month, but was still up by quite a few lbs. I had letters from my internist and my cardiologist saying it wasn't my fault and that the gain was because of my medical condition and meds I had to take. The insurance company didn't care, I still had to lose the weight I gained, PLUS the original 9lbs.

So I guess the answer is no, there is no way around it. Make sure you call your insurance company and have them mail you a copy of their requirements so you have them in writing. Study them and make sure you will be able to meet each of them (like my 5% excess loss, monthly visits, etc.), call and make your appt now and get started. Is it required to see an MD for those 12 months, or would a program like Jenny Craig suffice (VERY important to find out the distinction!)? Make sure that your doctor documents EVERY MONTH not only your weight, but what you are doing to try to lose weight. It can be as simple as documenting that you are eating more vegetables, that you have started walking 30 minutes a day, that you cut out sweets, that you are trying Atkins, whatever. But it MUST be documented EVERY MONTH.

Sucks, I know.

I was denied because I didn't lose the weight and all total it took me 15 months until I got covered. Had I known that was what was going to happen, I would have taken a loan and been a self-pay with Aceves or Rumbaut or Ortiz in Mexico. When I switched to this ins company I had been told it was a 6 month requirement, only to find it was 12 months. By the time I got into it, then denied, I got so mad I decided those f&%k#$s were going to pay for this surgery come heck or high Water.

I wish you both luck, get started NOW!

babs0101 · June 27, 2007

I've started. I saw the surgeon in May, and so it began. I've lost a couple of pounds so it is a start. A year is a long way off......but I also know that if I don't do it now, a year from now I will be wishing I had started!