Delay and insurance

[Grider 92]

What happens say I need to do some medical things before surgery- do just keep going for weigh -ins each month- insurance only needs 3 months of supervised diet,, and I am done with that, but may have to delay,, maybe,,, just wondering- how long will your visits to the NUT dr and psycologist good for?

[MelindaH 3]

What happens say I need to do some medical things before surgery- do just keep going for weigh -ins each month- insurance only needs 3 months of supervised diet,, and I am done with that, but may have to delay,, maybe,,, just wondering- how long will your visits to the NUT dr and psycologist good for?

Hi, I think with BCBS Fed it is six months. I will try to find out tomorrow and will post.

Melinda

[farmer2120000 1]

Here are some things to keep in mind about surgery for morbid obesity:

• Prior approval is required for outpatient surgery for morbid obesity. For more information about prior approval, please refer to page 17. • Benefits for the surgical treatment of morbid obesity, performed on an inpatient or outpatient basis, are subject to the following pre-surgical requirements: − Diagnosis of morbid obesity (as defined on page 52) for a period of 2 years prior to surgery − Participation in a medically supervised weight loss program, including nutritional counseling, for at least 3 months prior to the date of surgery. (Note: Benefits are not available for commercial weight loss programs; see page 34 for our coverage of nutritional counseling services.) − Pre-operative nutritional assessment and nutritional counseling about pre- and post-operative nutrition, eating, and exercise − Evidence that attempts at weight loss in the 1 year period prior to surgery have been ineffective − Psychological assessment of the member’s ability to understand and adhere to the pre- and post-operative program, performed by a psychiatrist, clinical psychologist, psychiatric social worker, or psychiatric nurse (see page 85 for our payment levels for mental health services) − Patient has not smoked in the 6 months prior to surgery − Patient has not been treated for substance abuse for 1 year prior to surgery • Benefits for subsequent surgery for morbid obesity, performed on an inpatient or outpatient basis, are subject to the following additional pre-surgical requirements: − All criteria listed above for the initial procedure must be met again − Previous surgery for morbid obesity was at least 2 years prior to repeat procedure − Weight loss from the initial procedure was less than 50% of the member’s excess body weight at the time of the initial procedure − Member complied with previously prescribed post­operative nutrition and exercise program • Claims for the surgical treatment of morbid obesity must include documentation from the patient’s provider(s) that all pre-surgical requirements have been met

What happens say I need to do some medical things before surgery- do just keep going for weigh -ins each month- insurance only needs 3 months of supervised diet,, and I am done with that, but may have to delay,, maybe,,, just wondering- how long will your visits to the NUT dr and psycologist good for?

[Grider 92]

Thanks, I wont know until later this week what Gastro dr has to say-- maybe nothing! :DI did see in OPM that the prices will go up a bit in our 2012 premiums, but that the benefits would be about the same.

[MelindaH 3]

Thanks, I wont know until later this week what Gastro dr has to say-- maybe nothing! :DI did see in OPM that the prices will go up a bit in our 2012 premiums, but that the benefits would be about the same.

I am happy about the premium news. Hopefully, the same level of benefits.

[Grider 92]

:(well. not good news yet- have to do a Esophageal Manometry test... Surgeon said endoscopy showed abnormal, so if I dont pass this - no lap band,

[Grider 92]

I have an appointment with a 2nd Gastro DR to get the manometry test next Tuesday,,, then the test, then the results,,, October may or not be my lapband month. well at least im back on track getting things done towards that and lost 2 lbs..