Bcbs Of. Il

[shastadaisy 20]

Mine is covered by bcbs BUT the group that manages my benefits (dupage medical) has these requirements before I can even see the surgeons office - they are very strong in this

[mike010906 14]

Actually' date=' why isn't your surgeon's office helping you out here? It is the surgeon that is wanting to get paid too...just saying.[/quote']

Great question! So I have been calling them because when my primary insurance was denied (which I knew it would be because they don't cover it, only secondary) they didn't call me. I had called them the next day, so this hurt my trust w/ them. They are normally very good and have been following up since submitting the information to my secondary insurance but because of that one incident I feel like I have to stay on top of it myself. :-(

[Smilejoelle1 19]

I can’t even talk to the surgeon until I meet the 6 mo of supervision with monthly weigh in and nut visits

I am h mo and the rules are different -

Here are my requirements from my group - which is more stringent than my h mo

Clinical Indications for Bariatric Surgery

[*]Growth has been completed (18 years of age or documentation of completion of bone growth).

[*]Body mass index (BMI) exceeding 40 or body mass index of 35-39 with at least two of these comorbidities (hypertension, dyslipidemia, type 2 diabetes, coronary heart disease, sleep apnea).

[*]Medical documentation reveals the member has been morbidly obese for five years or more

[*]Medical documentation reveals the member has failed a medically-supervised program of weight reduction spanning at least 6 continuous months of documented monthly weigh-ins, occurring within the 12 months preceding the request. Such a program would be expected to consist of:

[*]Documentation of nutritional therapy or medical nutrition therapy including a very low calorie diet (e.g. MediFast or OptiFast) unless contraindicated

[*]Behavior modification or behavioral health interventions,

[*]Supervised increase in activity

[*]Pharmacologic therapy (unless contraindicated).

[*]Maintenance support to continue to encourage nutrition choices to reduce health risk factors and maintain a healthy lifestyle.

[*]The surgical program must document the absence of significant psychopathology that would hinder the ability of an individual to understand the procedure or to comply with medical/surgical recommendations, or that documents psychological readiness for the surgery.

[*]Documentation of willingness to comply with preoperative and postoperative treatment plans

[*]Evaluation by an independent licensed psychologist or psychiatrist unaffiliated with the bariatric center.

Hi I'm wondering where was this taken from your groups policy or from the bariatric medical policy if do can you tell me which page? Thanks!