Blue Shield PPO- do u need to wait 6 months for surgery?

[bethk12@gmail.com 0]

Hi Everyone,

Just learned for Blue Shield PPO that I need to provide a record for a straight 6 month weight loss program within the last 18 months...I did Weight Watchers but have no records...I fell so depressed now...WHAT CAN I DO?

[Indymom 132]

Did you do weight watchers meetings or online? If you recorded your weight monthly online for 6 months, you could print a record of that from the WW site (or get the records from your meeting leader/secretary). Not sure if that works or not?

[Kayla 6]

I have Blue Cross Blue Shield PPO and I had to not only provide 6 months of weight loss but it had to be with a PCP!! Good luck you can do it I thought it would never end and now I am 12 days from surgery =)

[wondering1 103]

I had BCBS and they required the same thing for me. I had to do a 6 month supervised program through my surgeon's office. They do not bend on this requirement. Sign up for the program and just get started. The 6 months will go by quickly.

[bethk12@gmail.com 0]

thanks for your input....so depressed about waiting that I am thinking about paying the $20K out of pocket and use some savings..feeling desperate and can't stand myself or the pain in my body anymore

[wondering1 103]

It's not so bad. Really. I actually switched to Aetna half way through because they only require 3 months. Surgery in 12 days

[Adri 40]

I have Blue Shield PPO and only had a 2 week preop diet. The whole process from first consultation to surgery was about 3 months...I think that's a record. Maybe I did not have much of a delay because I have been obese since childhood and have diabetes.

[bethk12@gmail.com 0]

Thanks Heather. How are you doing since the surgery?

I have Blue Shield PPO and only had a 2 week preop diet. The whole process from first consultation to surgery was about 3 months...I think that's a record. Maybe I did not have much of a delay because I have been obese since childhood and have diabetes.

[ChunkyAndFluffy75 9]

Well i have BCBS PPO and i have to do the samething. I go monthly to my surgeons office for weight management and they have been tracking everything for the insurance company. Don't feel discouraged and the six months will fly by. I have my 4th appointment on 8/1/11 and will complete all the insurance requirements by the first week in October. YOU CAN DO IT!!!!

[Adri 40]

Thanks Heather. How are you doing since the surgery?

I've had no complications and a pretty typical recovery from surgery. The first month after surgery I lost 30 lbs and then had a 3 week stall. I have now lost about 4 more lbs. Beware of the first stall, it messes with your mind, not just your body!

[Roxyrooster 9]

That happend to me too. If you can contact WW and get records, you are in business,. If not, just start with a physican...my program with my doctor is very laxed. She has to record what I tried and what we talked about. I am in month 3. It is going by quickly.. Good luck.

[5DogMa 62]

I have BCBS of Louisiana. They told me NO 6 month wait period 3 different times by 3 different people when I called in to verify coverage from the beginning to check on this. That was February of this year. Then when my WLS office called they said 6 months consecutive visits! My first WLS visit was in May, then I went in June, I didn't go in July because I was moving, but went in Aug, Sept, October. I have a pre-op Nov 17 and surgery penciled in for Dec 7th. There is a chance they will deny me coverage! Even after my WLS told me this I called them and again they said NO 6 month waiting period! This was in August.. Criteria was BMI 35+ with co/morb or BMI 40+. My BMI was 42. Then with all this testing they found 2 co/morbs so I could drop below 40. My co-worker had WLS 2 years ago and did not have a 6 month wait period. I am really upset about this. I have met my max out of pocket because of all this testing and if I have to wait until next year it will cost me another $4,000 out of pocket!!! This sucks out loud!! Anyone else have this kind of thing happen? If I had known this I would have went to that July appt between all the moving. My WLS is sending in for approval this next week. URGH!!!!