BCBS 6 month required diet-need advice

[Lin12/20/07 0]

I, too, had to have 6 months supervised diet/exercise before the approval of weight loss surgery for my insurance. The most important thing, it seemed to me, was to have a doctor & insurance clerk who know what they're doing as these aren't easy to get approved.

It shouldn't matter if you started in December or not, but basically the insurance company will need 6 documented months of a visit with the doctor regarding supervising your diet & exercise- it's all in the documentation. The dr documents that he/she provided you with information on diet, discussed exercise, made suggestions, etc. Your doctor should also document monthly any obesity related complications- ex. sleep apnea, hypertension, diabetes, etc.

I actually gained like 3 pounds during this period (did really well the first month & after that was off & on....sound familiar?). But at the end, I wrote a letter to be sent with the doctor's information on the supervision that included what I DID DO in that 6 months- i included things like all the books I read on the band, stopping carbonated beverages, beginning a regular exercise program, learning to chew food more thoroughly, started Protein shakes & a Vitamin regimine, etc. Anything you did do in those 6 months to make progress toward diet & exercise or lifestyle changes or toward the band success, you could put in there.

My insurance approved my surgery the first time within 20 days. The doctor I saw for this supervision was an internist- not a wls surgeon. You should be able to see any doctor who is willing to do it & document/file for you but it would probably be best if it's the same doctor as with your new plan in 08. My insurance company said that they wanted it to be with the same doctor unless there was some unusual circumstance- to me the switching of insurances would be an unusual circumstance but I'm probably nicer than insurance companies!

I had the same fear- what if I lose enough weight where they say you can lose weight without the band. The dr told me, you have a BMI over 50, you're not going to lose enough weight in 6 months to put you out of the morbid obesity category. Wouldn't think the lower BMI's would either- because likely with your diet history they will see- losing the weight is not the bigger issue, it's keeping it off.

That 6 months will go by fast & it's good preparation time even if you don't do much dieting. You can emotionally, mentally, physically, and intellectually prepare yourself for the surgery. For me, the 4-5th months were the hardest to get through because the first few months I had other things to distract me (like getting cardio clearance, psy eval, etc for insurance). But after my 6th visit, everything flew by! You'll get there- hang in there!

banded 12/20/07

lost: 21 pounds (10 pre op)

[Fordgal88 7]

i also have bcbs of alabama. but mines with the gov. so i guess its the same. but i was told by my lap-band doctor i to do a 7 month diet not the 6 months. so it might have went up.im going the 3rd for the 5th visit and can't wait until i get done with it. i started at 409 and now im at 384. my lap-band doctor wanted me to lose 20 pounds so im good for now.

good luck.

My Dr. explained this to me. She said that its a trick they used to use to deny people. She said that when you hear 6 months you think 6 visits, but its really 7 visits (example - jan. - feb. = 1, feb - mar = 2, mar - apr = 3, apr - may = 4, may - jun = 5, jun - jul = 6). She said that she had a pt that had done 6 appts then waited 6 weeks and went to the surgeon and was denied because there was only 6 visits and she had to start all over because it had been more than a month from her last visit. Tricky Tricky!

[heather113076 0]

quote

[i had the same fear- what if I lose enough weight where they say you can lose weight without the band. The dr told me, you have a BMI over 50, you're not going to lose enough weight in 6 months to put you out of the morbid obesity category. Wouldn't think the lower BMI's would either- because likely with your diet history they will see- losing the weight is not the bigger issue, it's keeping it off]

Yeah my dr told me that I would have to lose 133 lbs in 6 months to have my bmi drop below the requirement. Luckily my dr is in the BCBS network. I am clear on the 6 month diet being 6 FULL months and not just 6 visits. I am going for my first visit with my regular dr on Jan 10, then for my initial consulation with the surgeon on Jan 16. I will be doing the phsych eval and other tests in the meantime to take my mind off having to wait another 5 months.

THANKS to everyone for the advice!

[cakegal 0]

When I first looked into lapband surgery I was told that my Insurance would cover it 100% (Great-West). I was so excited and did everything I needed to do to start the process, then I'm told I need 5 years history of BMI equal to or greater than 40. Since I didn't think about surgery 5 years ago I never went to a doctor unless I was ill. Needless to say I have very little on weight documentation. I do have 3 documentations from my old doctor stating my weight right at 40 BMI starting January 2003 and going well over 40 BMI in 8/06. Plus I have current records for the past 2 years from my PCP. Does anyone think this is sufficient?

Also I need to do a 6 mo. suppervised diet :confused::mad: Going from thinking I was 100% covered to well, just jump through these hoops first, has really bummed me out. Any tips on making sure I do 6mo. diet correctly? My PCP has never done this before either.

Thanks for your help. I really admire everyone who has educated me on the lapband. I know more than my PCP does. It's kind of weird.

[Lin12/20/07 0]

What about your annual ob/gyn visits? Any hospital visits? Even sick visits usually get weight because they have to know weight for prescriptions. Use ANY medical visits you made during those 5 years.

I needed a "weight history for 5 years prior" for my insurance. I didn't do it myself, the insurance clerk went through the records but she did mention that it was difficult to comb through all the records and get an annual weight history for the 5 years. She got my ob/gyn records as well as my pcp records and found and circled all the annual weights for 5 years and forwarded to insurance company. Just get any and all medical records for anyone that you saw in the last 5 years.

My thought would be if they say they require a 5 year history, they will use that to deny it if you don't have it. You could call the insurance company, too, and ask, hypothetically, if you did not seek any medical treatment in the 3 years prior to the 2 years you have documentation, how would they handle that in meeting the 5 year requirement. They may have a flow chart that tells them how they can deal with those situations- maybe it's acceptable if documentation is submitted in a statement by you that you did not seek medical treatment for those 3 years. Better to find out now what you're dealing with. In the end, that 100% coverage is great- you might have to go through a bit more but you save a great deal. Best of luck!

[Lap_dancer 8]

I wish BCBS would just make their mind up. In Florida they won't cover the surgery (which turned out to be just fine because I used Dr. Kirshenbaum in Colorado and over half of my posts are just reams of Kudos about him and my experience).

I have found that the doctor and/or a FEMALE behind the counter in the office who deals with the insurance can just be full of information. Try pumping them for tips.

[gamboagirl 0]

Why do they want you to be so unhealth to get your life back! I'm a BMI of 35 and I hate it. I've been a BMI of 30 since 2002, documented.

Ins is so not fair to those who need help! That is just cruel to HAVE TO BE over BMI of 40. The Lap Band is approved for BMI of 35 and every lb of weight you have on you makes for more difficult surgery and recovery and greater risk of General Aneathesia!

Geez... That is terrible.

[lindatabr 0]

Hi! I am one of those who has been trying to get everything in order to have my surgery approved since Feb. 2007. My BCBS of AL does state that it takes 6 months of documented supservised weight checkups. My doctor and I began the journey in March. She retired in August. According to her records, she saw me for 6 months and I should have been approved. She moved to FLA thinking I was on the way to a healthier, happier, smaller me. The bari dr I am trying to use sent my paperwork in and everything looked in order. Came back denied because there wasn't the 7th month in there. The documentation does read 6 months. I am now appealing because my doctor has retired and I did everything that "we" thought I needed to do. I did all the tests and paid for them that the bari dr wanted done. But you want to know what gets to me the most? I've had to do everything myself w/out any assistance from the bari drs office. All they did was fax in the packet when it looked like all my paperwork was there. When I didn't hear from BCBC in 6 wks, I called them to see what the problem was. They said they had sent a rejection letter to the bari drs office like 3 wks prior. I was steamed. I called and left a msg demanding to know why they never bothered to call me. I got a call back 3 wks later......told me I was denied and there was nothing they could do to help me unless I wanted to go w/the self-pay out of pocket plan. I'm pretty sure I slammed the phone down. So now not only am I

appealing the turndown by ins. but I am looking for another bari dr in my area of North Alabama.

Thank you all for listening. I'm proud of all of you for sticking with it and getting what you need for your own good health.

In my appeal, I'm even going to show them how much money they are going to save if they go ahead and approve the lapband surgery!! :-)

Linda

[sf911dispatcher 0]

I have BCBS AL also...I just got banded on Jan 03, 2008. I had to have 7 months in a row of seeing a DR. for weight loss. If you want too long like a week between months, they make you start over with the 7 months diet again. My surgeon waived the psych eval, but BCBS required that I still have it done, along with 2 years worth of medical records.

The surgeon told me BCBS didn't care if you lost weight, just that you tried, but if you are close to the cut off BMI for approval I would watch it. Hope this hopes

[kaninag 35]

see I'm worried about getting screwed too bc my doctor waived the pysch eval........

[JASON R 0]

its getting closer for me too. i got 2 more visits for the 7 month thing. and i got to still do my sleep study and my psych eval. im just worried about getting turned down. but my family doctor has done this before and sayed i have nothing to worry about.

[sf911dispatcher 0]

Jason R, I also have BCBS of AL and it is Gov. also...I got approved...so hang in there. The psy evl it is nothing, they just want to make sure you are able to handle the changes and not go out and kill everyone

[cakegal 0]

Okay, I just want to get everything straight. When you have a 6 mo. diet does it mean that a paper needes to be filled out, say Jan. as the start, then feb. another paper filled out which nets you 2 papers and one month, so at the end you actually have seven papers and six actual months or do you need 7 actual months?! I do not want to get to the end and be denied because of 1 month or stupid paper work, (which no one seems to know the answer to in the medical profession).

I'm sure the pysch. evaluation is to be sure you don't kill anyone regarding your insurance and not the actual weight loss. LOL

[JASON R 0]

Jason R, I also have BCBS of AL and it is Gov. also...I got approved...so hang in there. The psy evl it is nothing, they just want to make sure you are able to handle the changes and not go out and kill everyone

thanks for the heads up on it. i cant wait to get this done. im being working really hard on this and just would hate to fight the ins. company to get it done.

[JASON R 0]

Okay, I just want to get everything straight. When you have a 6 mo. diet does it mean that a paper needes to be filled out, say Jan. as the start, then feb. another paper filled out which nets you 2 papers and one month, so at the end you actually have seven papers and six actual months or do you need 7 actual months?! I do not want to get to the end and be denied because of 1 month or stupid paper work, (which no one seems to know the answer to in the medical profession).

I'm sure the pysch. evaluation is to be sure you don't kill anyone regarding your insurance and not the actual weight loss. LOL

ok, this is what i was told by my doctor. i need to have a 6 month watched diet by my family doctor. which means 7 visits. like this-

start first visit here---> july-sept=1,sept-oct=2,oct-nov=3,nov-dec=4,dec-jan=5,jan-feb=6. now i hope the doctor was right about this too. but as you can see you go seven times (7 visits) to your family doctor or who ever is doing your diet program.

but i actually got to go tomarch because my family doctor had a medical em. to deal with on my 5ht visit day. so it got moved 6 days. so that makes me going to the first of march. and he made sure it wasnt going to mess me up any. and i pray to god it dosent.