YOU MUST READ THIS if . . .

Your health coverage comes from Blue Cross Blue Shield of Illinois, Texas, Montana, New Mexico or Oklahoma in 2019! (And probably should read it even if you're not!)

Why? Those 5 companies are part of HEALTH CARE SERVICE CORPORATION (HCSC) and they are making a major change which affects anyone insured by them in 2019 who is considering having bariatric surgery. The HCSC Bariatric Surgery Medical Policy no. SURG716.003 is going to become effective February 1, 2019 and, believe it or not, they are eliminating any formal requirement that patients engage in supervised weight loss for a particular time frame (e.g. 3, 6, 12 months, etc.) prior to surgery.

READ MORE HERE: BIG NEWS! Several insurers are going to REMOVE pre-surgery supervised diet requirements

Wow this can be major for all the Bariatuc Hopefuls! Thank You Walter for this update!

I won't be surprised if most doctors and hospitals still have their own "bariatric program" They'll probably be similar in length just to stay competitive. Ultimately a lot of customers/patients are going to be looking at going to whatever place can get them to surgery day the quickest.

OMG! My new insurance plan starting in Jan 2019 is Anthem Blue Cross Texas. I know bariatric is covered in my policy and there was literally nothing else mentioned for requirements in the EOC aside the surgery needing to be medically necessary and performed at a BDCSC facility. This is awesome news!!! Thanks for sharing!

Happy to share - best of luck.

Thank you for sharing. I have Blue Cross Blue Shield of Massachusetts. I’m really confused because the doctor said I need 6 months of supervised diet whereas my insurance says that’s not necessary. Right now I need to reach out to another doctor to get a second opinion.

This is fantastic 

I have a legitimate question, please? Speaking as a therapist and a RNY vet.

What is it about taking away the supervised program that is attractive to those of you that are seeking surgery? Is it that it takes away one of the multiple hoops we already have to jump through or is it that it shortens the length of time before scheduling surgery?

The biggest reason I ask is because it seems kind of scary for me because so many folks I work with (and folks here, too) are already saying that they felt so unprepared for life after surgery, I'm afraid that shortening the timeframes even more will make it even worse. So much of the medically supervised time should be for the "pre-work."

I just really worry that this is a secret way for insurance to come back later and say "see, this bariatric surgery thing isn't working. All these people are gaining their weight back. We should stop covering it."

I know, I know - it sounds like a conspiracy theory, but I deal with insurance companies not wanting to pay for services so often (3 sessions after a suicide attempt? Sure, that'll be plenty! [emoji849]), it just wouldn't surprise me. ?‍♀️

~SW: 278 CW: 165~
RNY 1/5/2005
"What got you here won't get you there."

Sadly, I've confirmed that my insurance, Anthem Blue Cross (California), still requires dietician consults for 6 months. So I guess my Blue Cross plan is just not the same type of plan discussed in this article

I have completed the seminar and turned in my paperwork to the surgeon's office.

I have BCBS IL and spoke to them on the phone last week. While they no longer are requiring the supervised diet to approve, they did say that surgeons may require their own supervised diet plans so it seems they are leaving it up to the surgeon but they don't require it.

Exactly! It's a medical decision which should be reserved for physicians. However, I hope bariatric programs don't make mandatory diets a requirement of their programs as a knee-jerk reaction to insurer demands - even when insurers don't "demand"! Why? Because there is no evidence-based medicine to support mandatory diets! Here is more information to help:

ASMBS Position Statement On Insurer-Mandated Pre-Surgery Weight Loss Requirements

My Anthem BCBS (California - Prudent Buyer plan) doesn't require supervised diets, but we still have to do 6 months with a dietician. I'm not required to lose anything.

Exactly! It's a medical decision which should be reserved for physicians. However, I hope bariatric programs don't make mandatory diets a requirement of their programs as a knee-jerk reaction to insurer demands - even when insurers don't "demand"! Why? Because there is no evidence-based medicine to support mandatory diets! Here is more information to help:
ASMBS Position Statement On Insurer-Mandated Pre-Surgery Weight Loss Requirements

So I saw the surgeon today for the first time and he is going based off BCBSIL's requirements and expects me to have surgery in 2-3 months once I complete the nutritionist, psych and pre OP testing and everything is submitted to insurance for approval. No supervised diet required by my surgeon if insurance doesn't require it.

Here's the thing. I don't find value in not receiving nutritionist guidance from your surgeons office. On so many boards I see what am I supposed to eat questions. Well where was the guidance from your bariatric clinic

On 01/03/2019 at 00:02, Amanda Dutton LPC said:

I have a legitimate question, please? Speaking as a therapist and a RNY vet.

What is it about taking away the supervised program that is attractive to those of you that are seeking surgery? Is it that it takes away one of the multiple hoops we already have to jump through or is it that it shortens the length of time before scheduling surgery?

The biggest reason I ask is because it seems kind of scary for me because so many folks I work with (and folks here, too) are already saying that they felt so unprepared for life after surgery, I'm afraid that shortening the timeframes even more will make it even worse. So much of the medically supervised time should be for the "pre-work."

I just really worry that this is a secret way for insurance to come back later and say "see, this bariatric surgery thing isn't working. All these people are gaining their weight back. We should stop covering it."

I know, I know - it sounds like a conspiracy theory, but I deal with insurance companies not wanting to pay for services so often (3 sessions after a suicide attempt? Sure, that'll be plenty! [emoji849]), it just wouldn't surprise me. ?‍♀️

~SW: 278 CW: 165~
RNY 1/5/2005
"What got you here won't get you there."

I agree with this post 100 percent! I think we need the time to get our head in the right place. I have my surgery in 3 weeks and I know I would not have been as successful if I wasn’t forced to jump through these hoops. Only time will tell how successful I am in the long run. I hope doctors continue to require at least 4-6 months

On 1/3/2019 at 7:02 AM, Amanda Dutton LPC said:

The biggest reason I ask is because it seems kind of scary for me because so many folks I work with (and folks here, too) are already saying that they felt so unprepared for life after surgery, I'm afraid that shortening the timeframes even more will make it even worse. So much of the medically supervised time should be for the "pre-work."

Might be, might not be.

I personally think you can't be prepared for "after surgery". There is no realistic simulation of post-op life. And there will always be people who won't feel "prepared". However, I fear a lot of them won't even feel "prepared" after going through supervised diet for 6 years instead of 6 months.

This feeling of "lack of being prepared" reminds me of residents who're diving head first into their first on-duty-night alone. They almost never feel "prepared". I didn't feel prepared for many things on the job as well - and I mastered things anyway. Just like (most of) the residents that are now in fear of their first on-duty-night will master them.

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I just really worry that this is a secret way for insurance to come back later and say "see, this bariatric surgery thing isn't working. All these people are gaining their weight back. We should stop covering it."

Not that unrealistic I fear. However, enough people are already gaining back their weight and some more on top of it, despite the waiting and preparation period.

Of course one can draw two entirely different conclusions out of the fact that many people are gaining back weight:

1) patients need longer preparation time so results will be better

2) preparation time is wasted time, there will always be people who're going to gain back the weight, no therapy works for 100% of the patients

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What is it about taking away the supervised program that is attractive to those of you that are seeking surgery? Is it that it takes away one of the multiple hoops we already have to jump through or is it that it shortens the length of time before scheduling surgery?

For me it was length of time. We have wasted so much time already on stuff that didn't work long term, why waste more? Look at the studies on morbid obesity and conservative treatment. Not one seems to come to the conclusion that non-surgical treatment is successful.

Edited March 6, 20197 yr by summerset