Anthem BCBS

[nicole914 0]

Hello.

I have an Anthem BCBS of Ohio Preferred PPO.

They sent me information about what is covered and it comes down to the "medically necessary" issue. My weight puts me at a medically necessary level but my question is about Part 2 - previous attempts as weight loss and speaking with my doctor. :thumbdown:

Can anyone tell me what information they provided about previous weight loss attempts - Please? It does not mention anything about a time frame but wanted to know if they were verbally told one.

THANKS FOR YOUR HELP!

[PinePal 9]

Well I wish I had more information for you. I am in the same boat, I have Anthem BCBS NH. I have sent in 5 years of weight history form my previos doctor (good thing she noted when I went in that I was dieting) so it shows ups and downs. Hopefully that works. It is still being reviewed by my surgeon's office before it gets submitted to BCBS. Good Luck. :thumbdown:

[nicole914 0]

Thank you for letting me know. Did they ask you for a specific diet plan? I know that for myself, I have been on diets for what seems like forever...

[PinePal 9]

The only specific Diet mentioned in my medical records is Atkins. . . becuase I lost a lot a weight. . . of course I also gained it all back plus some too. I, like you, feel like I have always been on some sort of diet.:thumbdown:

[nicole914 0]

Please let me know how it turns out. My fingers are crossed for you!

[ccarter8219 0]

Hello.

I have an Anthem BCBS of Ohio Preferred PPO.

They sent me information about what is covered and it comes down to the "medically necessary" issue. My weight puts me at a medically necessary level but my question is about Part 2 - previous attempts as weight loss and speaking with my doctor. :thumbdown:

Can anyone tell me what information they provided about previous weight loss attempts - Please? It does not mention anything about a time frame but wanted to know if they were verbally told one.

THANKS FOR YOUR HELP!

Here is the information sent to me by BCBS of GA (Wellpoint) which is associated with Anthem BC.

Gastric bypass and gastric restrictive procedures with a Roux-en-Y procedure up to 150 cm, laparoscopic adjustable gastric banding (for example the Lap-Band® System or the REALIZE™ Adjustable Gastric Band), vertical banded gastroplasty, or biliopancreatic bypass with duodenal switch as a single surgery, is considered medically necessary for the treatment of clinically severe obesity for selected adults (18 years and older) who meet ALL the following criteria:

1. BMI of 40 or greater, or BMI of 35 or greater with co-morbid conditions including, but not limited to, life threatening cardio-pulmonary problems (severe sleep apnea, Pickwickian syndrome and obesity related cardiomyopathy), diabetes mellitus, cardiovascular disease or hypertension; AND
   
2. The patient must have actively participated in non-surgical methods of weight reduction; these efforts must be fully appraised by the physician requesting authorization for surgery; AND
   
3. The physician requesting authorization for the surgery must confirm the following:
   
   • The patient's psychiatric profile is such that the patient is able to understand, tolerate and comply with all phases of care and is committed to long-term follow-up requirements; and
     
   • The patient's post-operative expectations have been addressed; and
     
   • The patient has undergone a preoperative medical consultation and is felt to be an acceptable surgical candidate; and
     
   • The patient has undergone a preoperative mental health assessment and is felt to be an acceptable candidate; and
     
   • The patient has received a thorough explanation of the risks, benefits, and uncertainties of the procedure; and
     
   • The patient's treatment plan includes pre- and post-operative dietary evaluations and nutritional counseling; and
     
   • The patient's treatment plan includes counseling regarding exercise, psychological issues and the availability of supportive resources when needed.
     

:cursing: Hope this helps. Crystal

[StLouisGal 1]

I have Anthem BC/BS in Missouri. My primary physician wrote a letter outlining my diet and exercise attempts (failures) and weight history for the past five years and gave convinceing reasons why she thought it was an excellent option for me. The surgeons office required a 5 year weight and diet history. ( gave them 30 years worth) I had an appointment with a psychologist who also wrote a report for the insurance company. Your surgeon's office should know how to fill out the paperwork so it will go through.

Good luck to you!

[nicole914 0]

Thank you all for your comments!

Crystal:

I received the same information from them but I have a question for you.

This section:

1. The patient must have actively participated in non-surgical methods of weight reduction; these efforts must be fully appraised by the physician requesting authorization for surgery;
   

What exactly did you submit to the insurance company for approval?

Also, you had your psych evaluation and surgeon evaluation before you sent in the paperwork? Did you or the surgeon's office send it in for you?

[kdlee 0]

I have Anthem BC/BS PPO Ohio. I went to see my primary care doctor and he wrote a letter stating my previous attempts, such as Atkins, Weight Watchers, South Beach, and Phentermine. When I had my psych eveal, the psychologist went through my history and wanted to know every diet I had tried. Plus, when I had my history and physical done through the surgeons office, they wrote down dates and diets throughout my lifetime. What I did was just make a time-line and and wrote down every diet I could ever imagine being on. It all went through fine and I was not required to do a 6 month supervised diet. Good luck!:thumbdown:

[StLouisGal 1]

I have Anthem BC/BS PPO Ohio. I went to see my primary care doctor and he wrote a letter stating my previous attempts, such as Atkins, Weight Watchers, South Beach, and Phentermine. When I had my psych eveal, the psychologist went through my history and wanted to know every diet I had tried. Plus, when I had my history and physical done through the surgeons office, they wrote down dates and diets throughout my lifetime. What I did was just make a time-line and and wrote down every diet I could ever imagine being on. It all went through fine and I was not required to do a 6 month supervised diet. Good luck!:thumbdown:

The is just about exactly how mine went.

[ccarter8219 0]

Thank you all for your comments!

Crystal:

I received the same information from them but I have a question for you.

This section:

1. The patient must have actively participated in non-surgical methods of weight reduction; these efforts must be fully appraised by the physician requesting authorization for surgery;
   

What exactly did you submit to the insurance company for approval?

Also, you had your psych evaluation and surgeon evaluation before you sent in the paperwork? Did you or the surgeon's office send it in for you?

Yes, I had the doctors office submit everything. I just gave the doctor a list of all the diets I had tried and failed, and a list of my weight fluctuations over the last 5 years. I had the psych eval and the nutrition consult all done before the paperwork was submitted.

hope that helps. Good luck!!:thumbdown: