BCBS 6 mos diet requirement & comorbidity questions

[SummerShadow 27]

On 3/2/2017 at 3:41 PM, LeaninLanc said:

I have BCBS of Minnesota. I had similar questions so I called the BCBS offices and spoke with someone about the six months requirement and also had it emailed to me so I would be fully educated. I think that's a good starting point.

Thank you.

[SummerShadow 27]

6 minutes ago, OutsideMatchInside said:

It is hard because they make it that way on purpose. Obese people are still a group of people that it is okay to discriminate against.

A lot of WLS programs make people jump through pre-op hoops to prove they are "worthy" or surgery and will be compliant hoping it will lower post-op complications.

In the past insurance has made it difficult for people to get approved because they thought WLS was expensive. Now with Diabetes increasing and the cost of diabetes being so expensive, a few years ago a lot of insurance companies eased the path to WLS because it is more cost effective for them to get people to surgery ASAP.

I got my ball rolling my BCBS by calling them, verifying my coverage. Finding a Blue Center of excellence, and going there for the seminar. Going through my normal Drs was absolutely useless. I went to the Bariatric program and then they told me what I needed from everyone else, and I just hounded everyone to get what I wanted as fast as possible. So I went from first visit to surgery in 8 weeks.

ETA:

I read your prior post, which you wrote while I was writing my post. That sucks but you need to get rolling on this 6 months ASAP if you want to have surgery this calendar year. The year is already almost 1/2 over.

I agree! I can't get the patient advocate to return my calls, and she's the ONLY one in the office who can tell me if my doctors sent in everything needed. It's frustrating, but that surgery center is the only one even remotely nearby (1 1/2 hours away) that has experienced, qualified surgeons. I was told by a tech who did my stress test that my surgeon has done a ton of the gastric sleeve surgeries and he was a great choice. But I can't even get to the person who can tell me if they received everything required from my doctors. :/ I'm stressed beyond belief right now.

[dstgirl11 22]

I also have BCBS of AL and I started this process in 2016. I had to get 6 months of weight check-ins at thetot hospital's clinic. Each weigh-in had to be signed by a doctor and faxed to the surgeon. I did have two co-mobilities (sleep apnea and high blood pressure). In November of 2016, my paperwork was submitted and after three weeks I was denied. The insurance company want three years of documented weight from PCP (2013,2014, and 2015). The surgeon office had 2014, 2015, and 2016. Well, I didn't have 2013 because my PCP moved her practice and I did not find another doctor that year. So, I went with their second choice of dated photos from 2013 and a letter of medical necessity from my PCP. The insurance held my paperwork for a month without making a decision. So, I started calling them and doing live chats. Still nothing. Finally, my last live chat did the trick and two weeks later, I was approved.