I *think* I'm Covered! Bcbs

[Tana_Q 20]

I worked up the nerve to call my insurance company and just ASK. YES, the VSG is covered as long as it is a "medical necessity" and not for cosmetic reasons. That's it. They said the doctor just has to document the necessity. I didn't want to jinx myself and ask about the 6 month supervised diet so I asked if there were any other restrictions or documentation they needed and they said no. Oh how I hope this is true!

I have Empire BCBS in NY.

[MeMeMEEE 206]

Take a look at the general medical policy for Empire here. It doesn't have a 6 month diet listed BUT the 2nd bullet:

The individual must have actively participated in non-surgical methods of weight reduction; these efforts must be fully appraised by the physician requesting authorization for surgery;

That makes me think you will need to be very in depth with any weight programs you have tried when you speak with your surgeon. Note: Your employer may have a medical policy of their own so definitely double check and you can even ask Empire to send you a copy of it. Best of luck!!

[Tana_Q 20]

Thanks , I did see the medical policy. I thought that was kind of a regular thing that most insurances would want? In other words wouldn't they want people to have tried other methods before attempting surgery? I, as most of us here I'm sure, have tried multiple things! I will be as detailed as I can be with the doctor. I don't think my employer has their own policy as one of my colleagues had WLS and had it done within 30 days of starting the process!

I'm trying to be very optimistic about the whole thing. Maybe thinking +++ thoughts will do some good. Only time will tell! Thanks again and I hope you heal fast.

[MeMeMEEE 206]

I agree, seems pretty normal. I guess my worry would be how does it need to be proved? It doesn't specify so that kind of leaves it open. If you did weight watchers and have your weigh in records or tracked on line and can print a record I would take that to the surgeon, just in case! That is awesome that it sounds like you can have it done so quick! Best of luck - and I agree - STAY POSITIVE!

[Tana_Q 20]

This is embarrassing but I actually used to WORK for Weight Watchers. What a success story huh? LOL! I can get a letter from one of the leaders there stating I attended at different times.

But this brings up a great question. How does anyone prove weight loss efforts? I'm sure there are some people that did stuff on their own or used online programs. How does one get documentation? Maybe if one has a questionable (by insurance standards) weight loss attempt history then an insurance company might request some supervised diet attempts?

[MeMeMEEE 206]

I made lifetime in 2003 on Weight Watchers, gained it all plus 37 lbs back... I would get that letter! I had to do a 6 month supervised diet per my insurance requirement (BCBSIL). I have heard some have been able to show WW books to get past that with BCBSIL but I was told specifically that I had to see my primary Dr for 6 months. Hopefully your insurance is straight forward - sounds like you have some back up with the other person you work with having such a quick turn around!! I work for BCBSIL (HCSC so also TX, NM and OK) so I pretty much knew what I had to do from the start but also my program is very familiar with our insurance so that was awesome! Lots of employees have had bariatric with my surgeon.

[Tana_Q 20]

Yes I am also a Lifetime member. I have WW books from 1997-1998! I don't have my current books but hopefully the letter from my leader would be enough.

The thing I find silly about seeing one's primary doctor for the 6 month supervised diet is that most doctors get little to no nutrition training! So what exactly is the point of the 6 month diet? Do they think some people will change their minds?

[Living again 11/17/2011 40]

I have Empire BCBS and I was approved in days went to primary and got letter and hypertension arthritis and borderline diabetic call them haunt them thats how I got covered had my surgery 11-17 down 42 pds

Good luck

[Living again 11/17/2011 40]

I sent t hem my membership though i never went to bcbs but once and gym membership

[Tana_Q 20]

Thanks Raquel. I have heard more + things about my insurance since I first posted this so I'm really hoping it will go as smoothly as yours did.

[justkeepsmiling 3]

Not sure if this is still relevant but I know how stressed I was before I was approved so I figure I'll just post this anyway! I have Empire BCBS. My consultation was on December 8th, dietitian on December 16th and then my psych. evaluation on December 23rd. That was the Friday before Christmas weekend, and I don't know when they got back into the office and submitted to insurance, but even if they submitted on the 26th, I was still approved on January 13th.

I may or may not have had prior weight loss attempts documented in my paperwork, because the day the letter was faxed from my PCP to my suregon's office, I had already been approved, but it was submitted after approval just to cover all my bases. I'm nineteen with a BMI of 37 and two co-morbidities. They automatically approved me - which I absolutely was not prepared for, I was prepared for a fight - and didn't require a diet or anything.

Best of luck to you!

[Tana_Q 20]

Thank you, that is encouraging for sure. That's great that they automatically approved you. So did you get a surgery date yet? Who is your surgeon? You're not far from me at all, I'm in Yonkers :wink1: . I'll guess and say you're going to Northern Westchester or Dobbs Ferry?

[justkeepsmiling 3]

Northern Westchester is it! Haha. Dr. Roslin is my suregon. I was at work when I got the call that I was approved, so I got a voicemail from his secretary. I'm calling tomorrow to schedule but I'm aiming for March 8th, because it's the Thursday before spring break for me. I'm pretty excited. Have you had a consultation with anyone yet?

[Living again 11/17/2011 40]

He did my sisters surgery congratulations

[Tana_Q 20]

Northern Westchester is it! Haha. Dr. Roslin is my suregon. I was at work when I got the call that I was approved, so I got a voicemail from his secretary. I'm calling tomorrow to schedule but I'm aiming for March 8th, because it's the Thursday before spring break for me. I'm pretty excited. Have you had a consultation with anyone yet?

Congrats! I was initially going to go to Dr. Roslin, he has a good reputation. But then my insurance changed a bit so I decided to stick a little closer to home as it may be a bit cheaper for me to do so. I am going to Dr. Weber at White Plains Hospital. It's a small program but I like him a lot. Also my surgery should happen quickly too, I'm hoping by the end of next month. I have nothing to plan around except work so I can do it anytime really. I can't wait!