BCBS Federal Requirements for Lap Band

[BigOBoy123 67]

I am in the beginning stages of getting my lap band and I need to know if BCBS Federal Basic requires 6 consecutive months of documentation of me being on a diet plan from a doctor. I read on a website that BCBS as of April 2012 did not require this documentation. Is this true. I hope it is. Thanks.

[muelle 64]

I know every BC/BS plan is different. I have Highmark BC/BS and they do require the six month supervised diet. I had my surgery two years ago and my daughter had hers two weeks ago. It took 18 months and two different six month supervised diets to get my daughter approved. They denied her the second time and I appealed it. They said she had to see a nutritionist and a doctor every month, and she had only been seeing the doctor. Fortunately they approved the appeal, but I recommend you call your insurance and have them send you the requirements in writing and ask them to specifically explain the requirements to you. It is heartbreaking to jump through all the hoops and get denied. Good luck to you!!!

[grownazzkid 206]

I have BCBS Fed and was just banded 2/21. I went to True Results clinic in Austin. Three month of diet counseling and two years of medcial history (from regular doctor) indicating that you have been 40+ BMI (or under 40 & 2 co-morbids liek high bp, sleep apnia, diabetes...). I did not have a full two years so I had to write a letter of sorts talking about my weight history and struggles to lose weight.

Started first week Oct, last session mid-January, got letter of approval in a week, surgery less than a month later.

So far my out of pocket has been $25 per visit, $35 for psych co-pay, and $100 when I checked into hospital. Based on EOB's that have come in I am expecting another 1300-2000 from hospital, anesthesiologist, and whatever else they come up with.

[hely88 883]

All I know is I have BCBS of Florida and they don't pay for any of my fills.

[destynee1 417]

I had BCBS and I didn't need to do diet. I only needed 1 Nutritional visit and a history of my failures with dieting from my Dr.

[m1aman 944]

I had to dance for three months and got approved in about 10 days.

[BigOBoy123 67]

Thanks guys. You all have been awesome. So far I have been to my first seminar with my surgeon and got the required paperwork to send back to them. I called my insurance provider BCBS and they said I had to show 3 months of prior weight loss documentation. I already have that so I should be good to go with everything else that is required. I am so ready to get this done, I hope I dont have to ait much longer. Can you guys tell me how long you were off work after your surgery? I am a Correctional Officer so my job is pretty physically demanding and do not want to risk getting ina fight and hurting myself due to the surgery. Thanks.

[Drummergirl 10]

I have BCBS & they did require it. It took them 2 years to approve me. They kept delaying for this or that.

[pinx 18]

BCBS - fed requires 3 months of supervised weight loss, a nutritional assessment from a certified nutritionist, a psych evaluation, plus meet all of the requirements to get the lapband (40+ BMI or 35+ BMI and comorbid conditions) and have tried to lose weight on your own multiple (not specified as far as I know) times and failed or gained it back. I am stuck at the psych eval, but otherwise am done. The superviser at the psych clinic is holding on to my eval after going on vacation despite my calls and my doctor's calls.

If you need any more information just let me know... I am going through the process myself and have called them many times and my doctor's office is great at keeping me in the loop with the process. I can even tell you what my copays have been so far.

[pinx 18]

BTW, the diets you have tried on your own and failed may be the 6 months of documentation. I am not sure on that, but I have done WW multiple times, went through my doctor's weight loss clinic, and tried various other diets. I didn't have to provide paperwork to show the diets I had tried. I just had to list them, the estimated dates, and how much I lost.

[pinx 18]

Oh, and from what I have read, you will only be off for a week unless your job description would require longer. That would be up to the doctor. I started the process at the end of January, and all I am waiting on, and have been waiting on, is the psych evaluation to come back. After that, I was told it only takes up to 5 days for approval from BCBS-fed.

[BigOBoy123 67]

Thanks everyone. I am sure I will have many more questions as this process goes on. When I get closer to my surgery date I will also post some before pictures as I am sure I will frequent this website as time goes on..

[ladybug108 7]

Why is the psych eval taking so long? I did mine yesterday and he said he would get it to my doctor today. I am just waiting on my nutritional assessment. My doctor's office offer them so I don't have to go on a scavenger hunt.

How detail were your psych evals? I have BCBS Fed of Georgia....I think I will be ok. They pre approved me before, but I got scared and chickened out so I am trying this again.

[pinx 18]

I am also in Georgia. I don't know why mine is taking so long. The supervisor went out of town for a week though and now is holding it hostage! The doctor that did it said she's been done with it. We are just waiting for her supervisor to actually approve it. It is very frustrating and I would never recommend this place, but they took my insurance and the other one that did the evals did not take it. I had to do an interview, plus take the MMPI and PPI. I was told that once the doctors office gets the eval, I should be approved within 5 days. With the communication between the office, us, and BCBS, they think it won't even take 5 days. The waiting is frustrating because I was told it would be done Friday, then got the run around, then told Friday or Monday, then Tuesday they said this Friday at the latest but no one said Friday to start with... the thing is that my husband was there and heard the exact same thing! Once I get my results, I will be complaining on the supervisor who also talked about a patient on the phone while I was in the testing area. I heard details that I did not care to hear about the patient. Basically, I just think I went to an unethical place, but they do good mental health work. It is just the rest of it that is unethical.

BTW, both the doctor's office and I have explained why we need it back like yesterday! They don't care and keep telling us both it will be this day or that and then saying they didn't say that. I told them band or no band, I need surgery soon for another condition and they are doing both procedures together. Oh well, all I can do is hurry up and wait! I was suppose to be having surgery already and even the doctor's office said they've never seen these issues, but said it does usually take longer than 1 week like I was told. I was told it usually takes 2 weeks to get them back. The biggest issue I have is that I know the evaluations can be done quicker, because they are done within 24 hours for many job evals that require the full psych eval. Also, I have taken psychology courses and know how these tests work. The hardest part is taking the computer's results and putting it with the interview results, but still if they did the work, it wouldn't take 3 weeks!!! The worst part is that I had to wait 2 weeks just to get in, so I have been held up 5 weeks by this one evaluation that was suppose to be done 2 weeks ago.

[ladybug108 7]

Oh wow! My psych scored mine right then and there. I was in and out within the hour. He told me what the letter would say. I'm going to call doctor's in a few to confirm receipt. I think my doctors office is up on their game too. Please let us know how it goes especially since I have the same insurance. I kind of want to move my nutrition appt up. Its a month away!