The company I work for is self insured but uses BCBS to determine pre authorization. Today I was told that BCBS is requiring 6 months supervised diet. My company health plan says they won't pay for nutritionist visits. This makes no sense to me. How can it be required by the insurance company but they won't pay for it? Do you think I should skip going to the nutritionist and just ask my primary care doctor to see me for 6 months and document my weight. My health plan says they will pay for the psychological evaluation and they do pay for the Lapband surgery. Has anyone heard of a problem like this?

My insurance required psych eval and testing. They covered the eval, but i had to pay for the testing. That's insurance for you!

you could try a local weght loss clinic. If it is md supervised. Usually you see the dr the first visit and the nurse from then on. its cheaper than seeing your primary md all the time. plus sometime bcbs will reject a primary md assisted weight loss program.

I had the same problem with BCBS of MN. I had thought about arguing with them about it because it really is ridiculous to me but I didn't want to make them mad so that they would deny me. I also had to pay $300.00 to the dietitian at my surgeons office for pre and post op consults which also was not covered but yet it was required in the policy. Does not make ANY sense!!!

Robin

It helps to hear that others have gone through some of the same hoops. I spoke to the director of our HR Health plan group today and she agrees that this a unique situation. She suggested I appeal it. The company health board will meet in Dec. and she thinks it is a good time to bring this to their attention. I asked her how they handled other employees that have had gastric bypass or Lapband. I also asked for a written copy of the requirements.

Were you able to get anywhere with the nutrition visits? I'm not sure if my plan covered nutrition visits, but the 6 months supervised diet & exercise was done by my PCP- with careful documentation of the diagnosis, comorbidities, food journals & exercise journals and review of those monthly. It was a $25 co pay monthly & that documentation was sufficient. You could also get the insurance definition of "supervised" diet- Hope you're well on your way now!