Blue Cross Federal Reasons to get Denied

[Angelcharm 13]

Hi guys,

I need some help. I am currently going through the 3 months supervised diet program with my nutritionist and went on a two week vacation a week after starting seeing her. I am now back from vacation and on my second visit turns out I have gained a few pounds which I know she was not happy to see. I now have a month until I finish the 3 months with her and she basically told me to do the best I can but I am afraid the insurance denies me. I have Federal Blue in Florida and in my initial weight in was above the 40 BMI required.

Do you think I can be denied if I don't lose any weight during the 3 months?

[Sosewsue61 3,185]

Every ins is different. Mine says ' no gaining' during the supervised program.

[Angelcharm 13]

Did you have Federal Blue?

[Flippista 67]

OP, I have FepBlue. I was told no overall gain. I started at 218, then gained after the first month. I became more compliant and my last weight was 214. I was approved. My surgeon deals with a lot of FepBlue patients and they were strict on not gaining. Use this last month to get under your initial weight! You can do this!

[GassyGurl 428]

Does anyone know of a document that details this for fepblue? The SBP makes no mention of this, but if there are other policy documents out there, I'd love to know what they are so I make sure I am compliant and have no surprises.

[Redmaxx 740]

I have BCBS FEP and I did gain weight during the 6 month supervised weight loss. However I did that at the VA for over a year before I even though about WLS. I had zero issues with BCBS FEP approving my WLS.

[Angelcharm 13]

Ok good to know. My initial BMI was over 41 on my 1st visit which was at a weight of 265. My second visit was just after I came back from being away for almost two weeks and during the time I gained 9 pounds so I was at 274. As of today, I have two and half weeks to see the nutritionist again and I am at 264 which is 1 pound under my initial weight. I am tracking everything I put into my mouth, working out 4 times a week and eating around 1,250 calories a day. Even so I drop a couple of pounds more, I am hoping I can be under my initial weight in and still over the 40 required BMI. Do you guys think I should be ok?

[mxpxchik11 48]

Ok good to know. My initial BMI was over 41 on my 1st visit which was at a weight of 265. My second visit was just after I came back from being away for almost two weeks and during the time I gained 9 pounds so I was at 274. As of today, I have two and half weeks to see the nutritionist again and I am at 264 which is 1 pound under my initial weight. I am tracking everything I put into my mouth, working out 4 times a week and eating around 1,250 calories a day. Even so I drop a couple of pounds more, I am hoping I can be under my initial weight in and still over the 40 required BMI. Do you guys think I should be ok?

I have bcbs federal and my doctor and his staff were very clear that if I gained any weight during any of the weigh ins that I would have to start my 3 months over. I would suggest calling bcbs. They are very helpful. I was able to talk to them about my surgery questions. I think it would easy your mind to know the straight forward answer.

[Angelcharm 13]

I tried calling twice and all they did was read the requirements over the phone that are on the booklet. My nutrients or the doctors office never said anything about gaining when I first started only clearly said to don't drop under 40 so not sure

[Sosewsue61 3,185]

Did you talk to customer service or a clinical intake specialist? Find out because sometimes all CS is allowed to do is read from the policy. Ask the intake specialist if there have been any exceptions.

It would be best if you drop your calories to 1000, cut all carbs to just non-starchy vegetable ones plus lean meats to make sure you have a few pounds leeway. I don't have your insurance company but mine says NO gaining. I am currently on vacation but am trying to watch what I eat, I am on vacation for the fun and beauty of the area and not food, although since we are on the beach I am going to the fish market to get fish to cook, we are in a timeshare so have a full kitchen. Make a commitment.

[Angelcharm 13]

I called today and the lady was extremely nice and basically told me that as stated the requirements are for you to complete the 3 months supervised diet regardless wether you go loose weight or not. Luckily for me as of today, I lost the weight I gained on vacation and now and I am 2 pounds less than starting weight. I am tracking all I eat and I have increased my exercise going to the gym at work during lunch and Orange Theory in the evenings.