I recently decided to start the process of getting weight loss surgery. I have an appointment for an initial consultation with a surgeon later this month. I’ve been trying to figure out the insurance requirements (BCBS of Tennessee) for covering my surgery, and I know the standard requirements of having a BMI over 40 and maybe having to do a 6-month supervised diet program, but I’m having a hard time finding any information on some of the other details.

My biggest concern is that I’ve seen some people here mention a requirement for documentation of weight history. I have been morbidly obese all my adult life, but I rarely go to doctors. I went to get a checkup and bloodwork a couple of months ago, but before that, I hadn’t been to a doctor in 7 or 8 years, so I basically have no documentation of my weight history. I don’t even have many pictures of myself because I am careful to avoid being in pictures due to embarrassment about my weight. What is typically required for weight history documentation?

Also, I’ve been on all kind of diets (Atkins, South Beach, Weight Watchers, Slimfast, Cabbage Soup, calorie counting, etc.), some of which were given by a registered dietitian, but they were a long time ago, in my teens/early 20s. I stopped doing fad diets over 10 years ago because I realized that yo-yo dieting always resulted in regaining everything I lost and more. So, I’m also worried that I won’t have sufficient documentation of my previous dieting efforts.

It took me a long time to get to the point that I feel not only that I need weight loss surgery, but that I am ready to put in the work and make the changes that I will need to make, but I’m afraid that I’m going to have to wait years for my insurance to approve the surgery just because I don’t have official records of my weight and diet history. I know my surgeon’s office will have to get the details from my insurance company, but I’d really appreciate any info anyone can give me so I know what to expect. Thanks!

I recently decided to start the process of getting weight loss surgery. I have an appointment for an initial consultation with a surgeon later this month. I’ve been trying to figure out the insurance requirements (BCBS of Tennessee) for covering my surgery, and I know the standard requirements of having a BMI over 40 and maybe having to do a 6-month supervised diet program, but I’m having a hard time finding any information on some of the other details.
My biggest concern is that I’ve seen some people here mention a requirement for documentation of weight history. I have been morbidly obese all my adult life, but I rarely go to doctors. I went to get a checkup and bloodwork a couple of months ago, but before that, I hadn’t been to a doctor in 7 or 8 years, so I basically have no documentation of my weight history. I don’t even have many pictures of myself because I am careful to avoid being in pictures due to embarrassment about my weight. What is typically required for weight history documentation?
Also, I’ve been on all kind of diets (Atkins, South Beach, Weight Watchers, Slimfast, Cabbage Soup, calorie counting, etc.), some of which were given by a registered dietitian, but they were a long time ago, in my teens/early 20s. I stopped doing fad diets over 10 years ago because I realized that yo-yo dieting always resulted in regaining everything I lost and more. So, I’m also worried that I won’t have sufficient documentation of my previous dieting efforts.
It took me a long time to get to the point that I feel not only that I need weight loss surgery, but that I am ready to put in the work and make the changes that I will need to make, but I’m afraid that I’m going to have to wait years for my insurance to approve the surgery just because I don’t have official records of my weight and diet history. I know my surgeon’s office will have to get the details from my insurance company, but I’d really appreciate any info anyone can give me so I know what to expect. Thanks!

They just mean you'll need six months going forward. Some insurances don't even let you backtrack. Mine did and I have a lot of health issues so had the history already but otherwise you would just need to establish six months with a doctor discussing weight health and diet.

I would call the insurance company tomorrow and ask specifics for requirements. My insurance also said they needed a weight history For the past 2 years and over the phone they kept telling me that I would need to complete a 6 month diet followed by a physician. My surgeon's office decided to send in for a prior authorization after my first appointment because I had already completed my psych eval and they said well we'll just see what they say. 4 days later, it came back approved. So you could also try doing that and then if it's not approved, they will get you specific requirements for approval. But I seriously doubt that you will need to wait years to establish that history. Usually I've seen 6 months as the max wait time.

Good luck though and don't get discouraged!

1 hour ago, BigSue said:

I recently decided to start the process of getting weight loss surgery. I have an appointment for an initial consultation with a surgeon later this month. I’ve been trying to figure out the insurance requirements (BCBS of Tennessee) for covering my surgery, and I know the standard requirements of having a BMI over 40 and maybe having to do a 6-month supervised diet program, but I’m having a hard time finding any information on some of the other details.

My biggest concern is that I’ve seen some people here mention a requirement for documentation of weight history. I have been morbidly obese all my adult life, but I rarely go to doctors. I went to get a checkup and bloodwork a couple of months ago, but before that, I hadn’t been to a doctor in 7 or 8 years, so I basically have no documentation of my weight history. I don’t even have many pictures of myself because I am careful to avoid being in pictures due to embarrassment about my weight. What is typically required for weight history documentation?

Also, I’ve been on all kind of diets (Atkins, South Beach, Weight Watchers, Slimfast, Cabbage Soup, calorie counting, etc.), some of which were given by a registered dietitian, but they were a long time ago, in my teens/early 20s. I stopped doing fad diets over 10 years ago because I realized that yo-yo dieting always resulted in regaining everything I lost and more. So, I’m also worried that I won’t have sufficient documentation of my previous dieting efforts.

It took me a long time to get to the point that I feel not only that I need weight loss surgery, but that I am ready to put in the work and make the changes that I will need to make, but I’m afraid that I’m going to have to wait years for my insurance to approve the surgery just because I don’t have official records of my weight and diet history. I know my surgeon’s office will have to get the details from my insurance company, but I’d really appreciate any info anyone can give me so I know what to expect. Thanks!

I also have BCBS of TN.

You can have a BMI of 35 as long as there are comorbidities. For me, it was sleep apnea. Go on their web site and look up the requirements, There are 3 pages. One for the psych to fill out, one for the surgeon, and one for the PCP. There is a 6 month supervised weight loss requirement with the PCP. My PCP was wonderful. SHe documented everything that was required - previous attempts at weight loss, current plan - like using smaller plates and all other efforts. She documented everything for 6 months, (you cannot miss a month or you start all over), and even though I did not lose a lot during that time, there was no problem getting me qualified. I dont thing BCBS even cares if you actually lose much - you have to lose a little bit, but if the documentation shows that you are making a good effort and still cannot lose 10% of your body weight, you quality. The wording is tricky. That is why you must print it out and read it over and over until you understand all the ins and outs of it.

Now, here is something to remember. BCBS will indeed pay for the surgery, pre op labs, and all that is associated with the surgery. HOWEVER< after the surgery, they don't pay for anything. So follow up appts, lab work, etc are not covered......... IF they are coded as "bariatric, obesity, overweight", etc. Labs need to be coded as "malabsorption, iron deficiency, chronic inflammation, etc - anything EXCEPT something that refers to the surgery or obesity. I got a bill for almost $1000 for my 6 month labs! I am having the office recode and resubmit. Just read everything carefully and make sure your PCP is on your side and has experience in getting these surgeries approved.

Thanks for the info! That is really good to know about the follow-up appointments. AZhiker, can you tell me where on the BCBS web site I can find the requirements document? I have looked and looked and haven’t been able to find anything about specific requirements. The only thing I can find is that the surgery is covered on my plan.

My BMI is well over 40 so that won’t be an issue, and I’m prepared to do a 6-month supervised weight loss program, but what happens if I do not have a documented weight history to prove I have been morbidly obese for at least two years? Will I have to wait until I have a two-year weight history before they will approve my surgery?

On 2/2/2020 at 5:23 PM, BigSue said:

Thanks for the info! That is really good to know about the follow-up appointments. AZhiker, can you tell me where on the BCBS web site I can find the requirements document? I have looked and looked and haven’t been able to find anything about specific requirements. The only thing I can find is that the surgery is covered on my plan.

My BMI is well over 40 so that won’t be an issue, and I’m prepared to do a 6-month supervised weight loss program, but what happens if I do not have a documented weight history to prove I have been morbidly obese for at least two years? Will I have to wait until I have a two-year weight history before they will approve my surgery?

Just google "BCBS of TN weight loss surgery" and you will get all the info. The documented weight history can be any time you were weighed at a doctor's office. And I;m not even sure they won't simply take your PCP's word for it.

1 hour ago, AZhiker said:

The documented weight history can be any time you were weighed at a doctor's office.

Well, that's the potential problem -- until a couple of months ago, I hadn't set foot in a doctor's office for 7-8 years. I guess I should cross my fingers that the insurance takes my PCP's word for it...

2 hours ago, BigSue said:

Well, that's the potential problem -- until a couple of months ago, I hadn't set foot in a doctor's office for 7-8 years. I guess I should cross my fingers that the insurance takes my PCP's word for it...

https://www.bariatric-surgery-source.com/blue-cross-blue-shield-tennessee-weight-loss-surgery.html

I think you will find the info here.

It says "Most recent attempt was within 2 years of request for surgery." This is documented by your doctor. As long as you have attempted to lose weight within the past two years, you will be fine. My doctor simply documented my attempts - Weight Watchers, Slim Fast, Atkins, South Beach, starvation, Over Eaters Annonymous, etc.

Edited February 4, 20206 yr by AZhiker

I think it depends on your BMI and any co-morbidities. BMI over 40 with comorbidities, they won't care about your weight history. Just don't gain weight during 6-month diet program. The fact you haven't seen a doctor for a 7-8 years will concern your surgeon. They really emphasized at my orientation that continuous follow-up is required. "Patients of center for life." Many patients who regain significantly a couple years after WLS have not maintained followup.

Have you kept up with preventive screenings like PAP smear, flu shots, and mammograms (depending on your age.) If you have neglected that care over 7-8 years, your surgeon will be concerned.

4 minutes ago, over65 said:

I think it depends on your BMI and any co-morbidities. BMI over 40 with comorbidities, they won't care about your weight history. Just don't gain weight during 6-month diet program. The fact you haven't seen a doctor for a 7-8 years will concern your surgeon. They really emphasized at my orientation that continuous follow-up is required. "Patients of center for life." Many patients who regain significantly a couple years after WLS have not maintained followup.

Have you kept up with preventive screenings like PAP smear, flu shots, and mammograms (depending on your age.) If you have neglected that care over 7-8 years, your surgeon will be concerned.

My BMI is well over 40 so that will not be an issue. I have not had any preventive screenings and I am in my late 30s. If the surgeon is going to be concerned, is there anything I can do or say to alleviate his concern? I get an annual physical at work and they always said I was fine, until last year when they said my blood pressure was high and recommended I go to a doctor, so I went to the doctor then. I have gone to the dentist regularly for years -- does that count for anything?

Are you on BP meds now? Does your annual physical at work include any blood or urine testing? Having regular dental checkup and teeth cleaning might be helpful to bring up.

2 minutes ago, over65 said:

Are you on BP meds now? Does your annual physical at work include any blood or urine testing? Having regular dental checkup and teeth cleaning might be helpful to bring up.

No, not on BP meds (or any meds) right now. PCP said my BP is borderline, not high enough to warrant meds yet. Work physical does not include any bloodwork (except the pre-employment physical when I started the job), and the only urine testing they do is for drugs.