Insurance Question: Weight Loss One Year Prior To Surgery

[Michele23456 0]

Hello all,

I'm new to the boards, and new to the whole WLS topic in general. I've decided to go through with it and have begun to look up my insurance requirements. Does anyone have any experience with the requirement, "evidence that attempts at weight loss in the 1 year prior to surgery have been ineffective." I have my first appointment tomorrow but just wanted to see if anyone had experience with this. Does it have to be something like Weught Watchers with records, or will my surgeon just listen to my attempts (slim fast, Atkins, etc.) and verify it with my insurance? I have had numerous attempts at organized programs such as WW, just not in the past year. Any help anyone could provide would be great!

[change 22]

Welcome Michele!

I'm not sure what kind of insurance you have, but I have UHC Choice Plus and I was required to do a 6 month diet; however, they accepted 6 months of Weight Watchers proof that I had. I had the stamps with my weigh in every week for exactly 6 months and that was accepted.

From what I have read on here it really varies so much from one insurance to the other, but just from my experience that worked for me. I hope that helps. Good luck on your journey!

[Michele23456 0]

Thanks for the reply! I have BCBS FEP (in MA- not sure if that matters). It also has a 3 month medically supervised diet requirement. The requirement I am inquiring about is a seperate requirement from that.

[besquared1426 49]

I have BCBS FEP, also. They require 3 months documented weight loss attempt. I was doing WW online but I was told it doesn't count since it is not documented, like the weekly WW weigh-ins are. I don't know anything about a separate requirement in addition to the 3 months documentation. What have you been told?

[Michele23456 0]

Hey thanks for the reply! I've only attended an information session and have my first appointment tomorrow, so I haven't really been told anything. I pulled that quotation directly from the requirement page (not sure if all benefit plan books are the same, but that was on page 54 under "the member must meet all requirements"). So what are you doing for your 3 months now? Did you start attending WW in person, or are you doing something with your doctor?

[besquared1426 49]

I am waiting for my initial consult, which is in two weeks. (Can hardly wait!) From the WLS seminar, I was told that the documentation would start at the initial consult, since part of the two-hour consult includes meeting with a dietician. My 3 months starts that day. After the three months of appts with the dietician and nutritionsit , they submit the paperwork do BCBS. That period reflects the weight-loss effort within one year of the surgery request.

[Michele23456 0]

That makes a lot of sense, thanks for the clarification! I have my first consult tomorrow and am also very excited (and slightly nervous!)...I guess my three months will start them. Do you know if they wait until the three full months are up (vs three visits, which would really be two full months) to submit paperwork?

[besquared1426 49]

No such luck! You have to do a full three months, or in effect, 4 nutrition appts. that way you show a full three months of attempted weight loss.

[Michele23456 0]

Not surprising, but figured I'd ask!