Has anyone been able to get authorized for surgery using appointments with your primary care physician? I have BCBS of Georgia and they require a 6 month supervised diet plan but I have been working on diet and weight loss with my pcp since Aug 2016 and only 3 months with surgeon. I was going to pcp about sleep apnea but we always talked about my plan for weight loss and he has obesity listed for each appointment. Surgeon says that he can use pcp visits for pre-auth but insurance company says it has to be visits for weight loss only. Anyone have similar situation that got authorized?

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I also have BCBS Anthem. You have to show a 6 mo documented weight lost program, not to say that it cannot be from your PCP and from another source. I would call BCBS and ask them. I would imagine that the surgeon/PCP would have to correctky word each visit to meet a certain requirement. Also each visit has to be exactly 30 days or more apart. So for example if your last visit with your PCP for weight lost was November 5th then your next visit with your Surgeon has to be after December 5th. I am not sure if there a limit to the gap between each monthly visit. But only that it has to at least 30 days apart.

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I have BCBC Anthem I took 6 months of monthly classes through a bariatric center of excellence. It took an hour each month in addition to the weigh in with the dietician. It was about education and training. There were PowerPoints and handouts. Things to prepare you pre and post surgery. It is about what behavior changes you make for the rest of your life. I don't know if PCP spend that much time each appointment with the patient and go through that much training and education with the patient.

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