I'm at step one of this process & have my appt with the surgeon next month.... so I'm brimming with questions, concerns, etc... with regards to what insurance requires and what may or may not count. I have BCBS AL.....

My question about the diet thing is this: My Endocrinologist (not my PCP) told me to lose weight (because I'm pre-diabetic) and to follow the plan on a paper she gave me. I went back later, and it wasn't every month because she didn't ask me to do that, and I'd gone from 328 to 280 (was a very restricted diet), and it was literally over 6 mos time from when she told me to follow the plan and when I saw her last (about a month ago) and I'd lost that weight. I know my weight goes up and down because it's unbelievably difficult to stick with such a strict diet when you've not had surgery (for many of us it's difficult anyway).

I wonder if that would count as 6 mos of doctor supervised diet since it was a plan she gave me and I followed? The only thing that didn't happen was monthly weigh-ins with her. She's an hour and a half away so monthly weigh-ins would've been a royal pain but she also didn't require or ask me to come in once a month to weigh in.

Any thoughts?

With regards to comorbidity requirements: My BMI is WAY up there, like 50, so I guess I don't NEED to have a comorbidity of any kind to qualify in that respect, but.. I do have the following and wonder if this helps approval?

Pre-diabetes
Arthritis
HBP (not on medication though)
sleep apnea (Can't use CPAP due to intolerance and causing bruising and pain so use an oral device)
High cholesterol
High Triglycerides
Fatty liver (NASH)
Stroke risk (Had a TIA in 2013, heart ablations in 2014 for AFib, SVT, and Atrial Flutter).

Thanks for your patience with all my questions. I'm having difficulty getting my PCP and my former PCP to get back with me about records showing my weight, BMI etc. I've NO idea what I even need from them but trying to be proactive (suggestions?).

Edited March 2, 20179 yr by SummerShadow
Clarification

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.

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.