Hello everyone. I had my request for surgery sent into bcbs last Tuesday after all of my pre op testing was complete. Today I received this message from my case manager. I tried to call to make sense of it all and basically am reading it as I have to wait another year for surgery. (WTF). How do I go about this message, I called up there and my case manager was busy. Now it's after 5 and I'm unsure how to somehow get my insurance to accept my request. SIDE NOTE: I actually do have a year worth of weight loss attempt consecutively since February of last year as written down for them to know. I just don't know how I can get my physician to document it... or idk if I have to do this for another year simply Bc I was not aware that I had to have 12 months of that documented with a physician or else I would have been seeing one.

If anyone can tell me their story or help me understand how to go about this, that will be much appreciated. Xoxo

All I know is my primary DR. Had to write a letter recommending this surgery would be good for me based on my medical problems. He knew I tried many attempts to lose Weight but failed. This letter was also given to surgeon. I had also joined a gym.
I did everything and still had to get approval before surgery. They still had to review.
everything. They required I do 7 month program.

One of the first steps that my insurance required was that my PCP write a letter of support and submit it to my surgeon (weight loss program). My program gave me a sample letter to give to my PCP which indicated what the letter needed to address. Once the weight loss program received the letter the ball started rolling.

One of the first steps that my insurance required was that my PCP write a letter of support and submit it to my surgeon (weight loss program). My program gave me a sample letter to give to my PCP which indicated what the letter needed to address. Once the weight loss program received the letter the ball started rolling.

All I know is my primary DR. Had to write a letter recommending this surgery would be good for me based on my medical problems. He knew I tried many attempts to lose Weight but failed. This letter was also given to surgeon. I had also joined a gym.
I did everything and still had to get approval before surgery. They still had to review.
everything. They required I do 7 month program.

Hello everyone. I had my request for surgery sent into bcbs last Tuesday after all of my pre op testing was complete. Today I received this message from my case manager. I tried to call to make sense of it all and basically am reading it as I have to wait another year for surgery. (WTF). How do I go about this message, I called up there and my case manager was busy. Now it's after 5 and I'm unsure how to somehow get my insurance to accept my request. SIDE NOTE: I actually do have a year worth of weight loss attempt consecutively since February of last year as written down for them to know. I just don't know how I can get my physician to document it... or idk if I have to do this for another year simply Bc I was not aware that I had to have 12 months of that documented with a physician or else I would have been seeing one.
If anyone can tell me their story or help me understand how to go about this, that will be much appreciated. Xoxo

You take your personal record to your pcp and have them blend it with clinical visits you made for the past year. Like your weight every time you went to the pcp.

I would go online to your insurance's portal that you log into and see if there is an email system within the portal and ask very specific questions.

Like this: Does the 12 month supervised weight loss program require a 12 office visits with the pcp, with the dietician, etc. Does the program require a medication trial? Does the program require specific documentation for exercise, what type and how much qualifies? Get very specific.

It sounds as if insurance companies are trying to get out of covering wls by discouraging people. Good luck