BCBS of Michigan 6 month diet

snuffy65 · March 13, 2008

So 7 months ago my doctor talked to me about being severly overweight . My BMI was 42 and now 43. Anways at that time he told me to go on a 1800 calorie diet, gave me a diet book, and told me walking 3 miles once a day, 5 days a week, would be fine. Every month I saw him (though not offically to keep tabs on my diet), and every time he would take my blood pressure and my weight. Dec, he recommended the lap band. Jan, i saw the baratrics doctor and started putting my papers together, getting the psyc eval done etc... My doctors gave the baratrics center my records and I get a call about a week later.

They said there is nothing from my doctor about 6 months of dieting. Today I went back to my doctors and he showed me what was recorded the last six months. 6 months ago on the chart he wrote a note saying i was overweight and a diet and excerise regimant was given. Then the rest of the 6 months were only weight and BP numbers. He already wrote a letter to be put in with my papers about how I need the surgery and that I tried dieting. However the lady at the bararics center said it is not enough and need mroe documentation.

Anyone else have similar experience. I am not sure if I should press my doctor to document things more? Or push the baratrics lady to send the packet out to the insurance company? Due to my schedule later in the year ,waiting another 6 months will not really work for me. I know already making excuses right? But really, my hands are tied on stuff happening this year.

Thanks in advance!:drool:

Tamihott · March 13, 2008

I would ask them to get the approval packet together and send it out. You never know what the insurance company will be looking for on any given day. If you do not get approved, at least you will know exactly what they are looking for. If you get an approval then you will be 6 months ahead on your lapband journey. Good luck!

snuffy65 · March 13, 2008

Well, I talked to my doctor again and told him I wasn't able to go to surgery again. He asked why and I told him insufficient records. He then looked at my charts and showed me the note he wrote 7 months ago and all the weight in on my "vitals" chart.'

I noticed the "vitals" chart was on red paper. So I called the baratrics center she said they didn't get that note in my records nor the "vitals" chart.

I am guessing my Dr didn't fax it cause it wouldn't turn out since it was on red paper. So I called back my doctor and they are sending the chart with the obesity/diet/excerise note, sending the "vitals" chart, and going to write a letter confirming that we saw each other for 6 months for the diet and exercise regiment.

I talked with the baratrics and they assured me that this will be enough.

I hope it is.

Robin Bird · March 13, 2008

Snuffy,

I have BCBS of Michigan (I live in Wisconsin) and they paid for 80% of my band surgery. Best of luck to you!

Robin

afisher4band · March 14, 2008

Snuffy,
I have BCBS of Michigan (I live in Wisconsin) and they paid for 80% of my band surgery. Best of luck to you!

Robin

Robin bird

I also have bcbs MI I live in NC - I do not have to have preapproval for my surgery with the type of ins I have since the surgery is outpat. It is covered as lond as I meet the criteria and I do . But I do have to have preapproval for the facility that the doctor is going to use. Did you have to do this? How long after your paper work was sent in did you have to wait for approval also the ins. company will not accept a fax they wanted it mailed!:biggrin:

Robin Bird · March 14, 2008

afisher,

I did not have "preapproval" for the band either, which was hard for me to understand. The bariatric coordinator at my surgeon's office told me that there is really no such thing as preAPPROVAL, and what you do is gather all your materials/records and proceed with the surgery "in good faith". That scared the heck out of me! I kept worrying that after I went ahead with the surgery they would decide not to pay!

I do not recall pre-approving the hospital myself (my surgeon requires a one night hosp. stay), so perhaps my surgeon's office did it. The bariatric coordinator sent in my materials for me. I never once spoke to BCBS. Things went pretty fast after I had handed in all my requirements.

If you have other questions, let me know.

Robin

tyrind · March 15, 2008

HELLO. I AM TRYING TO GET THE LAPBAND AND I ALSO HAVE BCBS OF MICHICAN AND THEY TOLD ME THE SAME THING ABOUT NOT DOING A PRE-APPROVAL. THAT IS SO SCARY CAUSE THE COORDINATER SAID WHEN THEY SEND THE PAYMENTS IN FOR PAYMENT AFTER SURGERY AND THEY IF THE INSURANCE DOESN'T PAY THEN ITS MY RESPONSIBILITY! THAT'S NOT GOOD.:confused2: ANYONE WITH BCBS OF MICHICAN, HOW LONG DOES IT TAKES FOR THEM TO SEND OUT THEIR REQUIREMENTS?? THIS PROCESS IS SO LONG. BUT I GUESS AT THE END IT WILL BE WELL WORTH IT:wink_smile:.

tyrind · April 6, 2008

Snuffy,
I have BCBS of Michigan (I live in Wisconsin) and they paid for 80% of my band surgery. Best of luck to you!

Robin

Hello. i have BCBS of Michigan & live in NC. Did you have to do the 6 month diet? Even if you had your last 5yrs weight record? This is just so confusing and frustrating. Also did they give you a preapproval. They told me that they do not do a preapproval. So how do they go about doing yours?? If you did the 6 month diet, how long did you have to wait to get the surgery?? I am so sorry for asking you so many questions but i need to know so i can go ahead & start my 6 month diet. please respond. thanks

Robin Bird · April 7, 2008

Tyrind,

I only needed a 3 month physician-supervised "diet" because that's what the BCBS in the state where I LIVE requires. I'm not sure why they operate like that, but maybe BCBS in your state is similar. Some of the things I did:

*see my Primary Care Physician for an initial visit and she noted in my records that I was beginning a low-calorie diet along with walking program)

*had required labs done

*see PCP once a month for 3 full months to record weight, etc.

*kept a "food journal" for all 3 months (notebook w/ all food & bev. recorded)

*kept an exercise log for all 3 months (blank calendar pages with all activity recorded)

*had PCP initial each page of exercise log & food journal at each month's visit

*got letters in favor of surgery and medical records from PCP, OB-GYN and psychiatrist

*typed a document that listed my weights through the years (as far back as I could) based on medical records

*submitted a copy of Weight Watchers record book

I was never pre-approved. As I noted in an ealier post to this thread, you fulfill the requirements set forth by BCBS and proceed in "good faith" that they will cover it. Scary, I know! This is where the bariatric coordinator at your surgeon's office comes in. It's their job to make sure you have everything necessary to submit.

Sorry I got so wordy. Other questions, just ask.

Robin