Bcbs Not Requiring Any Pre-op Non Surgical Weight Loss For Gastric Sleeve Surgery ?

[dreamkin 4]

HI! I am new here:) I will be joining BCBS Illinois in feb and will be jumping their hoops to have VSG. I came across this in my research today and am wondering what your thoughts are, or if anyone else has read related info.

it states that BCBS (Illinois, tx, OK, NM) has decided in conjunction with HCSC (their parent company) and ASMBS (american society of metobolic and bariatric surgery) to eliminate the pre operative 6 mth diet requirment. It states that it was announced on sept. 21, 2011. I have called bcbs and they say they have no knowledge of that policy change. HOWEVER... i have read a ton on this board and it appears that many people didnt know in febuary that they would be making the policy change from 3 mth diet to 6 mth diet that was done in march. AND in sept of 2010 people had no idea that VSG would become a covered surgery in Oct. so it seems like maybe you wont know about the policy change until it happens. thats what im hoping for. i will do this however i have to, but it would be amazing to not have to wait the 6 mths.

http://asmbs.org/2011/12/hcsc-removes-mandatory-pre-operative-weight-loss-requirement/

thoughts?

tricia

[Dooter 1,457]

OMIGOSH, OMIGOSH OMIGOSH!!! PLEASE TELL ME THAT IT'S TRUE!! We belong to BCBS Illinois as well! (I live in NM, but my husband is employed out of Chicago). I called a month or so ago, and they said it was only covered with the hoop jumping. We are paying cash, but it would be awesome to have some of it covered!! Can you tell me any more?

[Addict 0]

All of these states and companies purchase different policies from bcbs and it's hard to determine exactly which policy your particular employer has purchased until you get into the process. Even when you call to check, sometimes you get inaccurate information. mine is bcbs of nc and when i called was told that vsg was covered, but got denied in Dec because it wasnt. I had until Oct before I would have to start the process over again so I waited untill July to try again. As luck would have it, they started covering it July 1st when the new year kicked in. I had my surgery in Sept. There were no pre-op requirements for me (from my insurance). So, it's clear as mud most of the time. Turns out though, I was much more prepared for this journey because of the wait. So it all worked out. It is worth the wait. Good luck

[Deigh 15]

BCBS of nc here here and no preop weightloss but I did need several months of documented weight problems which was easy enough. As my doc says, no one wakes up heavy and decides to do surgery right off.

[Addict 0]

Yeah, I had to list all my past attempts as well.

[Swimmer 199]

I'm in nc too and waiting on approval with CA bcbs athem. Where are you having surgery? I didn't have the sixth month swl either but and wondering if we have all the facts. Every time I call I seem to get misinformation. It's frustrating.

[Swimmer 199]

Opps double posted

[Addict 0]

I'm in nc too and waiting on approval with CA bcbs athem. Where are you having surgery? I didn't have the sixth month swl either but and wondering if we have all the facts. Every time I call I seem to get misinformation. It's frustrating.

I had mine in Asheville. Except for the denial because it wasn't yet covered, all went smoothly with bcbs. Once submitted, they respond pretty quickly, a week or less on both occaisions.

[dreamkin 4]

well i do know my bcbs ill will cover the sleeve, and i dont need any certain period of time worth of documentation of my weight (UHC wanted a 5 yr consecutive history!) but as of now they DO require the 6mth diet. they have actually been really amazing helping me figure out EXACTLY what i need to do and how to do it. i will do the 6 mths if they need it, but this article gives me hope. my prayer is that once the new policy kicks in jan 1 they will update their requirements and i will be able to proceed immediatly:) maybe its a pipe dream, but its MY pipe dream lol! the thing that gives me real hope is that the ASMBS is a legit organization. they would not have posted that if it werent true. now just to see when it goes into effect, and if my husbands employers plan is included. fingers crossed.. toes and eyes too!

tricia

[MeMeMEEE 206]

Hi! I am actually employed by HCSC in IL. Here is a link to pending medical policies and I don't see anything there at this point. Second link is to the current medical policy for bariatric. Keep in mind, some companies have their own medical policy so it is possible that your company might have different guidelines. I don't work with giving coverage info so I don't see medical policies often - I didn't know about the change in March till a few weeks before - but a girl from work who does work with coverage info is the one who told me about it. My advice is this - follow the guidelines you are given when you call - and it can't hurt to keep checking back! You say you are getting it in February so make appointments for December, January and February - if the 6 months still stands you will be half way there! 6 months really equals 5 months from first to last visit. And it goes quick! Can you say where you have seen this info? I would be interested to read it!!

http://medicalpolicy.hcsc.net/medicalpolicy/home?corpEntCd=IL1&cat=PENDING&TARGETMED=PENDING&ctype=DESCRIPTION&pageSize=20&select=PENDING#hlink

http://medicalpolicy.hcsc.net/medicalpolicy/home?ctype=POLICY&cat=Surgery&path=/templatedata/medpolicies/POLICY/data/SURGERY/SUR716.003_2011-03-15#hlink

[MeMeMEEE 206]

Just read the article cited - I am confused because it talks about pre-op weight loss - they don't require weight loss now, only that you go through 6 months of a weight reduction program. No mention of actually losing while doing the program...

[dreamkin 4]

memeMEEE... the article talks about weightloss, but im sure they are referring to the 6 mth diet, because in the policy im told they need "6 mths of active participation in a non surgical weightloss program". i HAD thought about starting the weightloss months now, to save the time, BUT im not on the insurance yet. i wont be added until we actually get married feb 5th, so my fiance is concerned they wont accept the time put in before coverage.. OR even that they will hold it against me as some sort of "pre existing condition" issue. any thoughts on that? it would be great to hear what you all think of that logic! i dont want to do ANYTHING to jeopardize my chances at approval. THANKS:)

tricia

[dreamkin 4]

OH and im also concerned about starting the 6mths now because the dr i go to may not be my PCP once the insurance kicks in.. and ive read some posts that make me think BCBS wants documentation SPECIFICALLY from my pcp. ??

tricia

[indi1 66]

This is SO ironic! I have BCBS-IL and currently waiting for final approval. My request was denied on 11/29 because I only went to 6 visits to my pcp for the supervised diet program. I had to go to one more for a total of 7 visits to equal 6 months of total time. That last visit was resubmitted Wednesday and I am still waiting for them to review it again. I am curios to see when this removal of that requirement will begin. Knowing my luck it will be a soon as I get approved . I really don't know if that documentation must come from your pcp or some other weight loss program. I went with my pcp because she had experience of writing good documentation for bariatric patients. I will say this and I have said it before, every time I have called BCBS, they have given the best customer service I have ever experienced coming from a big company. I have been really impressed with that but there are still hoops to jump through and it takes time for documents to go from the pcp to the surgeon to the insurance company and its very frustrating. You just have to keep notes and follow up with folks to make sure they get documentation or send documentation. The hoops have really been a blessing in disquise for me because in the process I found out I have hemochromatosis. I am so glad I found out now and can start treatments before it was too late.

[MeMeMEEE 206]

Hmmm wouldn't have thought of the pre-x. Are you on your own insurance now? It's been my personal experience that if you have no lapse in coverage they don't consider pre-x - say you have Aetna now and change to BCBSIL when you get married - no lapse. As for it being from your PCP - that is what I was told but I have heard of others being approved with visits to nutritionists and one lady who had BCBSTX who got them to accept 6 months of weight watchers. Do you know what plan your fiance has? Like PPO or ***? If you do, the website has a provider finder and you can see if your current Dr is with them. Hope that helps!

OH and im also concerned about starting the 6mths now because the dr i go to may not be my PCP once the insurance kicks in.. and ive read some posts that make me think BCBS wants documentation SPECIFICALLY from my pcp. ??

tricia

Interesting on the 7th visit...

I will say I hated the 6 months but it really did go by quick. My program has all sorts of classes I had to take and nutritionist visits which helped me prepare for after surgery.

This is SO ironic! I have BCBS-IL and currently waiting for final approval. My request was denied on 11/29 because I only went to 6 visits to my pcp for the supervised diet program. I had to go to one more for a total of 7 visits to equal 6 months of total time. That last visit was resubmitted Wednesday and I am still waiting for them to review it again. I am curios to see when this removal of that requirement will begin. Knowing my luck it will be a soon as I get approved . I really don't know if that documentation must come from your pcp or some other weight loss program. I went with my pcp because she had experience of writing good documentation for bariatric patients. I will say this and I have said it before, every time I have called BCBS, they have given the best customer service I have ever experienced coming from a big company. I have been really impressed with that but there are still hoops to jump through and it takes time for documents to go from the pcp to the surgeon to the insurance company and its very frustrating. You just have to keep notes and follow up with folks to make sure they get documentation or send documentation. The hoops have really been a blessing in disquise for me because in the process I found out I have hemochromatosis. I am so glad I found out now and can start treatments before it was too late.