So I’ve done everything I was supposed to do with surgeon and they submitted to bcbsnc and now insurance is saying I need 12 month consecutive with weight loss. Why?!?!?! Would the surgeons office review all my paperwork at initial appointment have me do everything only to not have what I needed. I’ve paid for anesthetist endoscopy psych nut ultrasounds only not to use any of it if I have to wait 12 months. My pcp sent letter how I’ve been under his card for the last year and have not been able to lose weight and that it’s s medical necessity The language from insurance is obscure. Can anyone help with this. The last sentence is what gets me

“In advance of a commercially insured member receiving a bariatric surgical procedure, BCBSNC will first need to review the member’s medical records, including documentation of 12 consecutive months of active engagement in weight related treatment, as described above. Judgement regarding the scope, depth, and adequacy of pre-surgical treatment during the 12 months prior to surgery is at the discretion of the multidisciplinary weight loss surgery team, and BCBSNC does not specify the content of the treatment. “

On ‎1‎/‎11‎/‎2018 at 12:19 PM, Gotalose said:

If my Dr writes my letter of medical necessity stating for the last year you would think that would qualify for “judgement”

I hope this wasn't Novant's mistake because that is the hospital network my primary and surgeon are in that I am using

3 hours ago, Bhageerah said:

Congratulations on the approval! You will be having surgery tomorrow if everything goes right! I know that you are happy, I am 5 months out and the only thing that I wish is that I would have done it MUCH sooner! Drives me nuts because I used to work for the hospital that I did my surgery. Started working for a another hospital and went through their program and they ended up getting out of bariatrics altogether! Ended up having to go back to the other hospital ( would have gotten a 25% discount with my current employer) but oh well, thats life and at least I am 90 pounds lighter and feeling much better than I was over 6 months ago!! You will be just fine!

This is just what I needed to hear. Thank you

ive been running around getting work and other stuff done and it’s the first time in a week that I have paused and my nerves started getting the best of me

wow 90 lbs. that’s awesome. Do you mind telling me your stats? I would love to be down 90 6 months after surgery

WTG! Good wishes to you and know you'll do splendidly!

I did mine through BCBS of Texas. Equally annoying. Only required 4 months of a weight loss program, but they dragged out my approval for so long it took me 6 months to get a surgery date anyway [emoji849]