Highmark BCBS

[SisterWannaSleeve 61]

Hello,
I just reviewed the requirements from my insurance. I meet all of them however I am unsure how to document past attempts at weight loss. What was your experience with bcbs? How did you document and how far back was required? Thanks!!

[NH Dee 8]

Bcbs was going to deny mine at first because they wanted 6 month working with a medically supervised program. A case manager aka, nurse from bcbs called me and do asked me tons of questions to see if I aqually had all the knowledge I needed to be sucessful. She ultimately approved my previous authorization. I did work with a medically supervised program for 6 consecutive months within 2 years which is what they are looking for. Call bcbs and have them sent email the actually prerequisite to you. Dee

[SisterWannaSleeve 61]

Thank you Dee! So did you pass because you had the knowledge or because you completed a 6 month program within the last 2 years?

[NH Dee 8]

Hello, BCBS didn't want to approve because they are a new insurance company and I had United Health when I went to another weight loss doctor but I submitted all the other insurance information to them. They tried saying it had to be within this year under there plan and I fought back because it only said 6 months within 2 years.....doesn't say anything about which insurance company. Lol but my interview with my BCBS caseworker "nurse" told me at the end of our conversation that my surgery would be approved. Hope that helps. Dee

[ChellNC 162]

For my BCBS policy, the doctors had to document the 6 month weight loss efforts. Good luck & hope you get approved quickly!

[SisterWannaSleeve 61]

Thank you ChellNC! I have my appt on the 24th. Fingers crossed.

[megolego 69]

On ‎9‎/‎1‎/‎2018 at 6:47 PM, SisterWannaSleeve said:

Hello,
I just reviewed the requirements from my insurance. I meet all of them however I am unsure how to document past attempts at weight loss. What was your experience with bcbs? How did you document and how far back was required? Thanks!!

I was worried about this too because though I have done "documented" weight loss programs like Weight Watchers before, I haven't done any within the past year and my insurance wanted that. What I did was write a letter to my local Weight Watchers and asked them to write a letter stating all of the times that I did Weight Watchers (which they did) and that along with a note from primary doctor helped me get approved! Good luck to you!

[SisterWannaSleeve 61]

Thanks megolego! That was my main question to Blue Cross Blue Shield when I called them to discuss. The guy I spoke with said that it was basically up to my surgeon to compile a good case and there was no sense of direction he could give me I did find that odd. It helps so much hearing everyone else’s experiences I am just so nervous that I will be denied

[NYJenn 1,464]

BCBS gave me a paper where I filled out previous weight loss attempts (WW, Atkins, etc) I gave it to my doc and he signed the bottom. That was all

[ChellNC 162]

On 9/21/2018 at 3:39 PM, SisterWannaSleeve said:

Thanks megolego! That was my main question to Blue Cross Blue Shield when I called them to discuss. The guy I spoke with said that it was basically up to my surgeon to compile a good case and there was no sense of direction he could give me I did find that odd. It helps so much hearing everyone else’s experiences I am just so nervous that I will be denied

Many times when you call the reps don't really know answers to those types of questions. They know their piece and not much more. There are so many moving parts to health insurance now that it's easy to only know a little.

[SisterWannaSleeve 61]

Ugh I’m so discouraged! I saw my surgeon today and he said that 6 months of dr monitored diet is required pre surgery. He said it was an insurance requirement. I feel like I should ask again. Thoughts?

[NH Dee 8]

The explanation of benefits I got from BCBS... specifically stated I needed 6 months of Medically supervised weight loss attempts. Luckily for me, I had seen a doctor for non surgical weight loss and made the requirement. If your working with your doctor now....you almost there...just a little hiccup. Good luck!

[SisterWannaSleeve 61]

Hey Dee, I’m still weighing my options. My co worker’s had bypass done in March of this year and wasn’t required to do 6 months but her surgeon is 200 miles away . I would prefer to do it locally but not ruling anything out just yet. Thanks for the words of encouragement

[Diana_in_Philly 1,426]

@SisterWannaSleeve - my insurance did not have a waiting period, but my surgeon required a minimum of 3 months of counseling with the RDs and compliance with program requirements/education/medical testing before scheduling surgery. And 3 months flew. The most important part of succeeding at this (in my opinion) is getting your head in the right place. And that takes time. We didn't get to be the size we were pre-surgery by having a healthy relationship with food. Working through all that and making peace with how your life will be different and developing new patterns and habits takes time. 6 months isn't that long. From being around this community for a while, what I have seen is that the people who generally want to have surgery a week after they see the surgeon the first time are the ones that have the most trouble adjusting and have issues post-op.

It took me years to get to 300 pounds. If it was going to take 3 or 6 months to start the next new chapter of my life where I'd become half my size, I was ok with that.

Best of luck.

[SisterWannaSleeve 61]

Great advice Diana. If I think back to my previous history of dieting, I was most successful when I was completely prepared. Which means taking your time. I also have this illusion that the weight will just fall off but I know that is not the case and will require work (I’m lower BMI). Might as well get used to that aspect now. Just sucks to be as stubborn as I am and have a timeframe stuck in your head.