Insurance requirements

[rshaeb 0]

Is there anyone on here whose insurance didn't have any requirements other than the 35 or 40 BMI? I have called both my insurance provider and Human Resources for my employer and they are telling me that my plan doesn't mention anything about dietitian, psych or exercise requirements. The surgeons office has me tentatively on the 6 month until we can verify if this is correct.

[Libra_87 10]

Is there anyone on here whose insurance didn't have any requirements other than the 35 or 40 BMI? I have called both my insurance provider and Human Resources for my employer and they are telling me that my plan doesn't mention anything about dietitian, psych or exercise requirements. The surgeons office has me tentatively on the 6 month until we can verify if this is correct.

Mines didn’t! I have BCBS of IL. I only had to do those requirements, bc of the hospital I was going to get it done at required it. Good luck!!

[SueperGal 92]

I have BCBS of FL and it just says BMI 35 with co-morbiditys (sp?) or BMI 40. My surgeon gave me the following requirements:

1. 6 months monitored diet. He gave me very loose instructions (ex. exercise 30 min per day, track your food, eat smaller portions). I pretty much just show up at the first of each month to be weighed and ask any questions I may have. I have lost weight each month, so they have not said anything more about it.
2. Endoscopy (After month 4 visit)
3. Dietitian (After month 4 visit)
4. Psychiatric Eval (After month 4 visit)
5. Suggested that I attend the twice per month support groups they offer before and after surgery.

I attempted to call my insurance company, but they would not give me the requirements directly. They said I would need to request them through the surgeon's office.

The office coordinator explained that this is what BCBS has required for their patients in the past to be approved. From other stuff I have read, you have to make a case to the insurance company and these are sort of undocumented requirements. I asked questions along the way that I saw on here about weight loss requirements and the surgeon told me just not to gain weight or they may deny me and have me restart. My requirements did not really kick in until after month four. I asked about that and apparently most people drop out before then.

These requirements seem pretty standard from what I have seen here and on other sites. I have not questioned them much because they make sense to me. The 6 months have provided me a lot of time to research and really think this through completely. I have been able to slowly introduce changes that I will need for post op (ex. no caffeine, no carbonation, low carb, etc.). The endoscopy found a small Hiatal Hernia, which will be repaired during surgery. I do wish the dietician had been earlier in the process, but I think it is more focused on the 2 week pre-op and Post op diet than the lead up in my case. I have that appointment Thursday. The Psyche eval makes sense to me to be sure I know what I am getting myself in to. I have that this afternoon.

Now that I made it to Month 5, the surgeon went ahead and scheduled me for April 24th. I just have these last 2 appointments this week before the wait for insurance approval. I know 6 months seems like a very long time at the start, but as everyone says, it really does fly by! Hang in there and you will make it. We are with you!