I was just told by my insurance (BCBS WY) that i need a 5 year supervised diet through my dr. in order to be approved. I supplied 5 years of weight records because I was told they would only need that and proof that my bmi is over 40.. My bmi is 55. Please help.. Has anyone heard of a 5 year supervised diet??? I feel like i don't have 5 years...

I was just told by my insurance (BCBS WY) that i need a 5 year supervised diet through my dr. in order to be approved. I supplied 5 years of weight records because I was told they would only need that and proof that my bmi is over 40.. My bmi is 55. Please help.. Has anyone heard of a 5 year supervised diet??? I feel like i don't have 5 years...

My insurance company didn't mention the 5 yr diet until after we submitted. Then they came back with a denial stated that a 5 year supervised diet was necessary. I decided that I wanted to do this for myself and was able to self pay. I figure it was a 20,000 investment to myself.

Julie..

Hi I am carchasers wife and we are both trying to get the surgery.I had a question for you, did you try to fight their decision at all? The biggest thing for me is that we can't find that criteria in our policy and we had asked about a supervised diet and were told that there was none required by them, that the doctor may require one, but he doesn't. So we are just trying to figure out the next step.. Self pay or fight them. Thanks

Carrie

Julie..

Hi I am carchasers wife and we are both trying to get the surgery.I had a question for you, did you try to fight their decision at all? The biggest thing for me is that we can't find that criteria in our policy and we had asked about a supervised diet and were told that there was none required by them, that the doctor may require one, but he doesn't. So we are just trying to figure out the next step.. Self pay or fight them. Thanks

Carrie

I have BCBS ME. The only thing that touched on my past weight loss efforts were the forms I filled out for my initial consult with my surgeon. I just had to list all of my weight loss efforts over the years. I have no idea how the surgeon's office presented that to the insurance company. I had no issues getting approved. Does your surgeon's office have a clinical coordinator that deals with the insurance company? I would touch bases with whoever the person is that prepares and submits the paperwork to your insurance company. They should know how to present info in such a manner that it meets your insurance company's criteria. Personally I would have appealed had I been denied, as there was no way I could have paid for this myself. Good luck!

They do have a person who sends everything in to insurance and deals with them. She was blown away when I called her yesterday and she deals with BCBS wy all the time and said that she has NEVER in 20 years heard of a 5 yr supervised diet. There is no real way that I can afford self pay. It is just frustrating beacuse the doctor and the surgeon both agree that I am one of the best canidates they have ever seen for the surgery. THe lady from the insurance co was so snobby and said " Well you can't just wake up one day and decide that because you want to loose some weight that WE should have to pay for your surgery!".. What??? Like I just all the sudden woke up at 350lbs and went "whoa! I had better make my insurance company pay". It is ridiculous that a surgery that is MEDICALLY NECESSARY has to be preapproved anyways. If I had a hart attack and needed a triple bypass they would pay and that would cost WAY more than 22,000 bucks. Sorry for the novel I just needed to unload.. HEHE..

I've never heard of a five YEAR supervised diet. What a joke!

I've heard many insurance companies require a five year WEIGHT HISTORY from your doctor and some require a 6 month supervised diet...

It almost sounds like the person you spoke with was confused. It might be worth calling the insurance company again and act like you haven't talked to anybody (make sure you get a different person, LOL) and ask what the criteria are for approval for WLS. If the 5 year supervised diet thing comes up again, ask where that is in your policy because you did not see that when you read the policy to see if you even had coverage!

Julie..

Hi I am carchasers wife and we are both trying to get the surgery.I had a question for you, did you try to fight their decision at all? The biggest thing for me is that we can't find that criteria in our policy and we had asked about a supervised diet and were told that there was none required by them, that the doctor may require one, but he doesn't. So we are just trying to figure out the next step.. Self pay or fight them. Thanks

Carrie

I had called the insurance company before I even went for my first consult to see what was required. I had to be at least 80 pounds overweight, a certain BMI, have at least one problem caused by my weight (I had high blood pressure) and I needed to have a dr aggree with me that I needed the surgery. I thought "great", all these were true. Sent my packet & 10 days later came my denial "no record of 5 yr DOCTOR supervised diet plan". My surgeons nurse called the company and explained this was never stated to me, but they wouldn't budge. I had tried other diets for years but never under the direction of a doctor, which meant I would have to wait 5 additional years until they would pay for it. I just couldn't wait until I was 36 to start a new healthy life. So, decided to pay. Since you are both wanting this surgery, I would definitly try to fight it. Best of Luck!!

Hi I would try speaking to a supervisor. I agree that she may have been confused with the 5 year weight history. A five year weight loss seems ridiculous.

Good Luck

A question....do you see your PCP regularly? I waas Type 2 Diabetic and saw my doctor a minimum of every 3 months. Every time I started a diet, I discussed it with him and he would follow up with me on it...until, of course, I fell off the wagon (time after time). If I'd had insurance coverage at all, I would have had some consistent medical records of "supervision".....could that work for you?

A question....do you see your PCP regularly? I waas Type 2 Diabetic and saw my doctor a minimum of every 3 months. Every time I started a diet, I discussed it with him and he would follow up with me on it...until, of course, I fell off the wagon (time after time). If I'd had insurance coverage at all, I would have had some consistent medical records of "supervision".....could that work for you?

I had not had insurance so I saw the doc pretty much just when i was sick. I talked to a differnet lady today at BCBS and she said it is not a 5 year diet it is a 5 year history of my weight loss attempts that were doc supervised.??? Isn't that the same thing LOL. She called my PCP and he let her have it, so now she is saying that i just need to resubmit everything and include a letter from my PCP and surgeon. I am also going to write one and my boss said she would write one saying that my weight effects my job(not really true but that's ok) LOL!! So we will see what they say. I have 15 days to appeal, so i will keep you updated.

This does not sound right. Here in Texas we have been doing the LapBand for over 5 years, and I have never heard of a 5 year dietary requirement. Many insurance providers require a physician guided documented 5 year weight history showing obesity, but not a 5 year physician supervised diet. Ask your customer service rep to give you the link to the clinical policy bulletin on obesity treatment on their website or for them to email it to you.

Sounds like some miscommunication or misinformation.

I agree double check the insurance companies are full of bad information I was told one thing twice by two different people not I'm being told they informed me wrong....oops sorry about that.