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FL Anthem BCBS 6 month req HELP! :-)



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Posted (edited)

Not sure if anyone can give me advice on this one. I am just starting the process. I have been working with my dr on a dietary plan since September of last year. Here is my problem, I have dr visits in Sept, Oct, Nov, Jan, Feb and April but since I did not go in December and March the office I contacted believes I will have to start the process all over again for my 6 month weight loss. I find that ridiculous. Can anyone help me with this or give me some advice?

Thank you all!

Edited by mbone05
Wanted to add help

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I know that my office had 3 months of visits prior and they had to be completed by certain dates. I remember I had to move around some work meetings to accommodate the last date. I am sure the rules are determined by the insurance and each one makes up their own set of guidelines. Have you had a change to call your insurance and ask them what they require? It might be helpful.

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Yes, I called them and they sent me the guidelines this is how it is worded.

The individual must have serially documented active participation in a non-surgical weight reduction regimen for at least 6 continuous months, in the 2 years prior to surgery, to enable both behavioral changes and adequate assessment of anticipated postoperative dietary maintenance. These efforts must be fully appraised and documented by the physician requesting authorization for surgery.

The coordinator advised that there can't be any missed months. I just hate to start from the beginning.

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Did you happen to see your pcp during those missed months? That may be able to count.

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I also have Anthem BCBS, and doctors office says I need yo see a hospital based nutritionist every month for 6 months. My plan wording is the same as yours. I interpret it as needing to be continuous. No breaks. Unfortunately you may have to go back to April and start your 6 months there. :-(

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Thank you all for your help. I guess I was just hoping. I did see my primary care but not in the months of absence. :-(

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