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 BIG NEWS! Several insurers are REMOVING supervised diet requirements



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mg28olyfghi-300x169.jpg 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

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

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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.

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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!

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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.

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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."

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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 :(

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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.

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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

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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.

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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.

Sent from my SM-G960U using BariatricPal mobile app

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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

Sent from my moto e5 play using BariatricPal mobile app

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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

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