I was wondering if anybody had experience with the 6 month Dr. supervised diet required prior to approval of the lap band. The wording in my plan states that you must have been on a Dr. supervised weight loss plan for at least 6 months in the last 2 years. So.....starting in April of 2007 I started seeing a doctor for about 5 months. I then stopped for 3 months, started again for another 4 months and then saw him off/on over the last year. I saw him a total of 16 times in a 20 month period but never for 6 months straight?!?!?! I've read a lot of the posts and looks like it just kind of depends on the provider but I submitted my documents three days ago and am starting to get a little ansty.....

Thanks for all the help.

lose2-

If you don't mind my asking, was your 6-month supervised diet with the surgeon's office, or through your PCP? Were they specific about what was NOT included that they wanted to see?

I'm sorry you're struggling, and your case sounds like so many BCBS-IL cases I've heard about, hence my apprehension. My surgeon's office has talked about their struggles with them, and they try to send almost a rediculous amount of paperwork to insurance for approval because of that. My file is probably about two inches thick, at least.

6 month with PCP. All the letter said was "not specific enough". I called and asked what more they needed, she just repeated that. My doctor has left her practice, so I then ask ins. if I would have to just start over? She said yes. I told her I would call & talk to surgeons office about what to do. They told me, no, what you have should be fine, and sent my case to advocates. Thats where I am now, in a dark, abismal place called "Insurance Pergatory"!!!:crying: P.S. The file the surgeon sent to ins. co. is 65 pages long!!!!!!!!

My claim was submitted with BCBSIL and denied by some nurse there said I did not have my 5 year complete weight history and six month diet even though they were both submitted so they must have overlooked it! I am resubmitting my claim with additional weight history information and my doctors additional notes about my six month diet that include weight, portion contol, healthy diet, excercise. How many times can you try and be denied? Why did they deny I wonder I have submitted all the required documentations i.e. sleep study, blood work, nutritionist, 6 mo. diet, psych eval, 5 year weight history, letter of medical neccesity. I guess once my doctors office resubmits I will know if they approve this time around or not.:crying:

yikes...now i'm scared i'm so close I just need this to process the 1st time

Just Tired

Hello all! Well I'm just beginning this journey and already I see that I need to have all my ducks in a row ahead of time to avoid ever having to start over. So if you don't mind I just have a few questions.

I have BCBSIL however I'm in TX and in the city I live we have no approved Bariatric Centers I have to easily go 200+ for a surgeon. Will they accept the 6months of diet by going to my PCP, do I just ask him to be specific in the records, anything else he should be sure to add?

Also, I did do some dieting last year with Meridia however I then became pregnant, however I lost the baby etc and then didn't pick back up on my dieting until recently, it's my understanding they want 6mos. of consecutive records is that correct?

One additional question for now, the 5 year records, just general office visits over the last five years showing my weight etc will those work?

Any helpful hints anyone may have would be very much apprectiated. Thank you!

pnksplash,

I can answer a couple of your questions based on my experience......It actually says in the BSBS-IL policy that you must have been on a Dr. supervised weight loss plan for 6 months out of the last two years. I had speradic appointments over a 24 month period but never 6 months in a row and I got approved in less then two weeks. The general office visists will work fine for your 5 year history.

Good Luck

I called blue cross blue shield and I was told that I was not denied they just needed additional information from me. The Rep that I had spoken with was obviously misinformed. I turned in my necessary documentation and now I am waiting for a response once again!:thumbup:

Hey Bouks---were your sporadic appointments always about your weight? Or was it just documented each time you went?

I have BCBSIL and my appointments were with my PCP. They were never about my weight. They were about something else, but my weight was always discussed. That information, which included my diet plan and exercise plan, was sent in with my information from my surgeon's office. They were six months in a row.

Hello all! Well I'm just beginning this journey and already I see that I need to have all my ducks in a row ahead of time to avoid ever having to start over. So if you don't mind I just have a few questions.

I have BCBSIL however I'm in TX and in the city I live we have no approved Bariatric Centers I have to easily go 200+ for a surgeon. Will they accept the 6months of diet by going to my PCP, do I just ask him to be specific in the records, anything else he should be sure to add?

Also, I did do some dieting last year with Meridia however I then became pregnant, however I lost the baby etc and then didn't pick back up on my dieting until recently, it's my understanding they want 6mos. of consecutive records is that correct?

One additional question for now, the 5 year records, just general office visits over the last five years showing my weight etc will those work?

Any helpful hints anyone may have would be very much apprectiated. Thank you!

I am from TX as well with BCBS IL and indeed there is not blue cross bariatric centers but from what I understand if you have ppo then as long they are in network you will be covered 90/10 depending on your plan out of network is a different story. The six month diet will be accepted just make sure it is well documented about 1200 calorie diet, portion control, excercise. The 5 year weight history is the same that I used just general office visits. My claim has been submitted and awaiting response. Have you had your claim submitted yet? What city are you from? I am from Corpus Christi tx. would if be okay to swap email addresses? Mine is ravin2faith@yahoo.com

I did my 6 month supervised weight loss program with my doctor and BCBS-IL denied me. They stated on the denial form "It is expected that appropriate non-surgical treament should have been attempted prior to surgical treatment of obesity." I had all the appropriate paperwork filled out by my doctor and showed weightloss, but I was still denined. I am in the process of appealing their decision with help from the Obesity Law firm. I have been working on this whole process for 1 year now and I am wondering if I will ever be able to have this surgery.

I did my 6 month supervised weight loss program with my doctor and BCBS-IL denied me. They stated on the denial form "It is expected that appropriate non-surgical treament should have been attempted prior to surgical treatment of obesity." I had all the appropriate paperwork filled out by my doctor and showed weightloss, but I was still denined. I am in the process of appealing their decision with help from the Obesity Law firm. I have been working on this whole process for 1 year now and I am wondering if I will ever be able to have this surgery.

Do not feel bad I got a denial for the same thing even though I had a six month thorough weight loss program. I am not bothering with them. I am going to cancel with BCBSIL because they are there just to make a profit. We should have Michael Moore cover bariatric surgery specifically BCBSIL and I am sure they will cover it!

So please tell me what have you done since getting denied by BCBSIL?

I have decided to do the most bravest and commendable thing ever....loose weight on my own. I drink two protein shakes as meal replacements and a light supper--consisting of lean meat, low carbohydrates and exercise. I just started this past week and I hope that I loose weight. As far as BCBS I am going to reduce my health plan to the lowest plan until I find another provider. I in the near future plan to lobby congress for protection against insurance providers that do not cover medically necessary surgical interventions for the obese like me. What is your plan?

I am going to see if I can get my denial reversed but in the mean time go back to Weight Watchers. I will hope for reversal but I need to do something now beacause the weight keeps pilling on.

Same here...my weight kept going up that is why I decided to go into 2 protein shakes/day, light meal supper, and exercise. I feel great but the ultimate is when I weigh myself on Saturday--that will be one week and see if I lost a few pounds. Good luck to you! Keep me posted on how everything is going on your end.