Hi everyone!
I have BC/BS managed under carefirst administrators. When I met with my surgeon’s insurance specialist, I was advised that I didn’t have a 3 or 6 month nutritionist requirement, instead that I just had to get an upper endoscopy, psych evaluation, sleep study, nutritional evaluation and letter of medical necessity. I did all of that really quickly because for deductible purposes, I wanted to have the surgery done this calendar year. My coworker also started the process soon I finished everything and was advised that she had to see a NUT for 6 months. My paperwork was submitted to the insurance company yesterday so I’m hoping to hear from them early next week [with an approval!] but now I’m having a minor [read: major, monumental even] freak out because I obvs don’t have enough time to meet those requirements and have the surgery before year end.
Basically, I just need some positive energy that will assure everything will work out okay! I’m so ready to have the surgery done and officially be a part of the losing team. I wouldn’t be devastated if I don’t get approved but it would definitely suck.
I did reach out to my insurance company after speaking to the specialist in the beginning and these are the requirements they sent me:
1. Requires diagnosis of Obesity (BMI over 30).
2. If BMI is under 40 then a comorbidity is required (hypertension, diabetes, coronary artery disease, heart failure, obstructive sleep apnea, gastroesophageal reflux disease) is required.
3. The member must have a documented history of participation in a supervised weight loss program.
4. The member must be unable to lose weight despite sincere attempt.
5. They can’t have any active peptic ulcer disease or gastritis. Or evaluated and treated.
6. Endocrine (thyroid) can not be the cause of the obesity.
7. No alcohol or drug addiction or greater than 1 year since last used.
8. No cigarette smoking or smoke free for . 6 weeks.
9. No history of psychiatric disorder or disorder is managed.
10. Must have a dietary consultation.
11. Member understands surgical procedure, post compliance and follow up care.
12. The procedure must be done in a bariatric center.
Nothing about 6 month nutritionist visits but.. idk. Maybe I’m freaking myself out. Anyway, thanks for reading!

I'm crossing my fingers for you, girl! Maybe it'll be your Christmas present! I was approved by BCBSIL *** just days after the submittal. I did, however, have the 6 months of NUT visits.

I had BC/BS of Texas when I was sleeved and my pre-op requirements were almost identical.

My first consultative appointment to inquire about the sleeve was on 10/23/2014. My packet was submitted to BC/BS in mid November 2014.

Insurance approved payment for the sleeve on 12/26/2014, approximately 6 weeks later.

Although I wasn't sleeved until April 2015, I could have gotten surgery as early as February.

The moral of the story is there's light at the end of the tunnel. You can do this.

I'm crossing my fingers for you, girl! Maybe it'll be your Christmas present! I was approved by BCBSIL *** just days after the submittal. I did, however, have the 6 months of NUT visits.

Thanks love! I’m hoping it’ll double as a Christmas and birthday present because that’s on 12/11!

I had BC/BS of Texas when I was sleeved and my pre-op requirements were almost identical.
My first consultative appointment to inquire about the sleeve was on 10/23/2014. My packet was submitted to BC/BS in mid November 2014.
Insurance approved payment for the sleeve on 12/26/2014, approximately 6 weeks later.
Although I wasn't sleeved until April 2015, I could have gotten surgery as early as February.
The moral of the story is there's light at the end of the tunnel. You can do this. [emoji4]

Such reassurance. Thank you so much for sharing! My surgeon scheduled me for 12/18 so I’m hoping for approval, not denial for missing nutritionist visits. I talked to my insurance company this morning who said I should have an answer on Monday [emoji15] please cross your fingers and toes for me! Lol

I got approved!!!!! Two weeks from today I’ll be a sleeved mama [emoji24][emoji1487]