6 Month Supervision

[tjandjessie 0]

I have BCBS of Minnesota and I have to have 6 months superivision by a Dr. with a diet. This is so frustrating to me because I have been trying to lose weight on my own forever and I just want to get the surgery already and move on with my life.

Anybody know any ways around this? Any success stories?

[makemyownluck 785]

If it's their requirement, then there's no way around it. But ask them to clarify what they'd consider as part of that. If you've been going to Weight Watchers or can show you recently joined a gym, they MIGHT consider that as the start date. Otherwise, get yourself to the doctor ASAP and schedule a visit with a nutritionist.

Sorry you have this requirement. Your alternative is to go to Mexico and self-pay, or try to find different insurance. I'm sorry you have that requirement.

[NewAshes 232]

You don't have to lose weight unless the doctor tells you to lose a% of your fat cause of your liver or if they believe it will make the surgery easier. It's best to try though

[ISleevedIt 380]

I had a 6 month process also. I was a human yo-yo....losing/gaining all the time. I learned a lot during that time that helped with the surgery. Remember 6 months is nothing compared to the rest of your life.

[babelow 9]

I have BCBS MN as well and and just about done with my 6mo diet. But it has given me the chance to research and learn about myself, and the changes I need to make long term. I look at it like the preseason, and soon it will be real!

[Ginger6367 14]

I also have BCBS of MN. I started my journey in January 2013 and will be submitted for approval next week. My policy states; Patient must have a BMI>40, patients with a BMI 35-40 will be considered when there is documentation of a co-morbid condition.

2. The condition of morbid obesity must be of at least two years

duration. Because attempts to lose weight over this two-year

time period may cause the patient’s BMI to fluctuate around

the required levels, the two-year time period will not

necessarily start over, or be prolonged, but will be reviewed

on a case-by-case basis.

AND

3. Over the last year prior to surgery, the patient has actively

participated in a structured, nonsurgical weight loss program

(i.e.,, a program that provides diet, exercise, and behavior

modification strategies through individual or group

counseling) , for a total of six months with failure to achieve

weight loss goals or maintain weight loss. Participation in

one of these programs must be at least 3 consecutive

months in duration. Participation must be monitored by the

primary care physician providing medical oversight for the

patient and must be documented in the medical record

AND

4. The patient must be evaluated preoperatively by an eligible

licensed Mental Health Professional1 to ensure the absence

of significant psychopathology that would hinder the ability of

an individual to understand the procedure and comply with

medical/surgical recommendations

AND

5. The physician requesting authorization for the surgery must

confirm that the patient’s treatment plan includes a surgical

preparatory program addressing all the following

components in order to improve outcomes related to the

surgery and to establish the member's ability to comply with

post-operative medical care and dietary restrictions:

a. Pre-operative and post-operative dietary plan; AND

b. Behavior modification strategies; AND

c. Counseling and instruction on exercise and increased

physical activity; AND

d. Ongoing support for lifestyle changes necessary to

make and maintain appropriate choices that will reduce

health risk factors and improve overall health.

I know every policy is different but this is what my coordinator/insurance specialist has for BCBS of MN.

Good Luck!

[Macy6 356]

I am four months into my six months, I didn't realize that my first appt counted as my six visits (in my case, every office is different) When I realized it I went "eeeek" because the loss of that month made me nervous. It has taken me the full four months to read the books I wanted and really needed to read, to watch the documentaries that I wanted and needed to watch, to get through my "to do" list from the surgeons office, to go to my one required and the non required, but much needed support groups. I am like you, years of dieting and failures, but I really feel like I have learned more in this past four months than if I had, had surgery right away. The excitement and adrenaline of the thought of surgery calms down, and it gives you time to kind of sit back, relax and consider what you are doing. It seems like it is never ending, but it really isn't, before you know it..... you will be at that last appointment wondering where the time went.

[NewAshes 232]

I am four months into my six months, I didn't realize that my first appt counted as my six visits (in my case, every office is different) When I realized it I went "eeeek" because the loss of that month made me nervous. It has taken me the full four months to read the books I wanted and really needed to read, to watch the documentaries that I wanted and needed to watch, to get through my "to do" list from the surgeons office, to go to my one required and the non required, but much needed support groups. I am like you, years of dieting and failures, but I really feel like I have learned more in this past four months than if I had, had surgery right away. The excitement and adrenaline of the thought of surgery calms down, and it gives you time to kind of sit back, relax and consider what you are doing. It seems like it is never ending, but it really isn't, before you know it..... you will be at that last appointment wondering where the time went.

what documentaries did you watch?

[abj 11]

Tjandjessie--- I have this same deal--- it is very frustrating-- I think they are hoping we will give up,,,,but NO WAY!!

[klassiekassie 0]

I have the same requirement from BCBS and I have just completed my fifth month. It has actually been very informative and has given me different answers to questions that I have had. I still have to do my counseling session and I am having trouble with two years worth of weight history. but hopefully by the end of may I will be all done and just waiting for approval !!! Good luck to you all ......

[Kiki75 42]

Hi. I have same requirement to have documented 6mon with doctor. His scale sucks so not sure I will be so lucky. I feel like I've been to the doctor every month for some reason since December. Hopefully my doctor will be able to lay everything out so that will not push me back on a surgery date of July!!! That would be the BEST time of the year for me. It's a bit scary not knowing if it will happen and all based on this one hurdle..

[Kiki75 42]

Hi. I have same requirement to have documented 6mon with doctor. His scale sucks so not sure I will be so lucky. I feel like I've been to the doctor every month for some reason since December. Hopefully my doctor will be able to lay everything out so that will not push me back on a surgery date of July!!! That would be the BEST time of the year for me. It's a bit scary not knowing if it will happen and all based on this one hurdle..

And I have BCBS of NJ

[TES 858]

I have BCBS of PA and had to do the same thing...though there are variations based on an employer's plan. For instance, the post above says 3 of the 6 months have to be consecutive, but for me, it had to be 6 consecutive months. So one tip I would give is don't make your appointments at the end of the month--go for the beginning or middle of the month, and then if you or your doc need to reschedule, you will have a buffer. Because if you miss one month, you have to start all over again with the 6-month requirement.

I was disappointed at first about the requirement but it ended up being a great thing! I learned so much, especially from my dietitian, and I mentally prepared myself. I asked that my insurance submission be expedited, and I got approved in ONE day. Then my surgery got moved up by 2 weeks. Everything happened so quickly. Also, i was glad to have taken off about 20 lbs before surgery bc it did help with post-op mobility and recover IMO.