Just Decided To Do This

[Jessielynn 112]

ANYONE with bcbs Ill please pm me I have so many questions! Thanks

[mom2five 292]

Mine is BCBS WV PPO

height : 5 ft, weight: 270, BMI: 53 Cant wait to get sleeved!

[mom2five 292]

I called my insurance co. and asked about the requirements. The person I talked to said he didn't know what they are but my doctor will have a checklist.

I looked it up online. I specifically googled BCBS WV bariactric surgery requirements and I found my checklist. I still have questions though. I'd say my doctor's office will be able to answer a lot of my questions though since I'm sure they deal with this all the time. I'm impatient though!

height : 5 ft, weight: 270, BMI: 53 Cant wait to get sleeved!

[Barisaxylady 154]

My bcbs pop required 6 months of continious recorded weight loss attempts. I was able to submit my ww records from six months ago. Big sigh of relief on my end! Thing that made me laugh the most was they cover wls but they don't cover a nutritionist to potentially help you avoid the surgery. Insurance companies make absolutely no sense sometimes. Best of luck. I totally understand where you are coming from on the impatience end. Good luck and welcome to the board!

[mom2five 292]

Ok, I decided to login to my husband's insurance account and actually look at the policy to see what they require. It appears as if the policy for bariatric surgery was reviewed last November, and as of Jan. 2012, the requirements have changed.

Unless I am misunderstanding this, it looks like they have removed the requirement of the 6 month doctor supervised diet. I will copy/paste what it says, so I can get your opinions.

Here it is:

Medically Necessary:

Gastric bypass and gastric restrictive procedures with a Roux-en-Y procedure up to 150 cm, laparoscopic adjustable gastric banding (for example, the Lap-Band^® System or the REALIZE^™ Adjustable Gastric Band), vertical banded gastroplasty, biliopancreatic bypass with duodenal switch, and sleeve gastrectomy (open or laparoscopic) are considered medically necessary for the treatment of clinically severe obesity for selected adults (18 years and older) who meet ALL the following criteria:

1. BMI of 40 or greater, or BMI of 35 or greater with an obesity-related co-morbid condition including, but not limited to:
   
   • diabetes mellitus; or
     
     
   • cardiovascular disease; or
     
     
   • hypertension; or
     
     
   • life threatening cardio-pulmonary problems, (e.g., severe obstructive sleep apnea, Pickwickian syndrome, obesity related cardiomyopathy); AND
     

[*]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; AND

[*]The physician requesting authorization for the surgery must confirm the following:

• The individual's psychiatric profile is such that the candidate is able to understand, tolerate and comply with all phases of care and is committed to long-term follow-up requirements; and
  
  
• The candidate's post-operative expectations have been addressed; and
  
  
• The individual has undergone a preoperative medical consultation and is felt to be an acceptable surgical candidate; and
  
  
• The individual has undergone a preoperative mental health assessment and is felt to be an acceptable candidate; and
  
  
• The individual has received a thorough explanation of the risks, benefits, and uncertainties of the procedure; and
  
  
• The candidate's treatment plan includes pre- and post-operative dietary evaluations and nutritional counseling; and
  
  
• The candidate's treatment plan includes counseling regarding exercise, psychological issues and the availability of supportive resources when needed.
  

Sounds good, huh?

[Philly Yum 54]

Sounds like your in ! My BMi was very high at my first visit too and I was told I would need half the loops to jump thru just based on my weight. Congrats on taking the right step. First week out and another 10 lbs.

[ShrinkyDinkMe22 376]

That's what my letter said from bcbs. Same as what you posted.

[doxieville 799]

Hi! Welcome to our community! I was sleeved on August 21st. I had to go through 4 months of pre-op stuff. Seeing a nutritionist and a mental health doc once a month. I was a bit impatient at first until I realized that I should take advantage of the guidance. I'm fat for a reason and more support would help me be more successful. I lost 30 pounds pre-op and have lost 0 since my surgery. I'm bummed, but I the NUT warned me that my body needed to step back and reboot itself during seveal phases of this journey. And the mental health doc gave me tools to use to not get frustated when I don't lose.

So, whatever hoops you need to go thru, rememeber, they are in place to help you succeed, and not be a failure.

Good luck!!

[Raven21 121]

Sounds like you're good to go! I live in MI and have Aetna. Aetna requires 6 months of doc supervised or 3 months multi (psych, nutrition, exercise, doc), which I'm doing.

The coordinator at the bariatric center said if I had BC/BS of MI, they could have scheduled the surgery!

The kicker - my husband's company switched from BC/BS to Aetna in JULY!

Oh well, I figure I can use the 3 months to get into an exercise routine. And the more I lose now, the less I have to later.

[makemyownluck 785]

If you have a ppo, then the bcbs requirements you found online apply. If you have h.m.o. then your medical group actually has to approve the referral and their criteria might be different than what you found online. With an h.m.o., bcbs doesn't actually approve the surgery, your medical group does. It's always more confusing when dealing with an h.m.o.

[mom2five 292]

Hi! Welcome to our community! I was sleeved on August 21st. I had to go through 4 months of pre-op stuff. Seeing a nutritionist and a mental health doc once a month. I was a bit impatient at first until I realized that I should take advantage of the guidance. I'm fat for a reason and more support would help me be more successful. I lost 30 pounds pre-op and have lost 0 since my surgery. I'm bummed' date=' but I the NUT warned me that my body needed to step back and reboot itself during seveal phases of this journey. And the mental health doc gave me tools to use to not get frustated when I don't lose.

So, whatever hoops you need to go thru, rememeber, they are in place to help you succeed, and not be a failure.

Good luck!![/quote']

Good point. Thank you. :-)

height : 5 ft, weight: 270, BMI: 53 Cant wait to get sleeved!