6 month medically supervised diet policy changes?!?!?!?!

[butterflygrl1 1]

I just went through the same thing. I had to have my assigned insurance nurse call my bariatric center to tell them that BCBS does not require the 6 month weight management. It seemed that not everyone in BSBC was on the same page as to the policy change. I have found being pro active is helpful.

[Skywalker 170]

15K now for sleeve surgery or 100k later heart surgery

I know, right? It's like, duh. I was hoping the medical insurance companies would piece that one together.

Obesity can cause blood clots also, like the one my husband was hospitalized with a couple years ago, to the tune of $30,000. They really should more thought into these procedures as preventative, rather than cosmetic or experimental.

[lmaher718 38]

I have Qualcare.. And they are so simple

Saw surgeon August 1.. Set surgery date that day for Oct 1.. Did all my clearances already

Just marking the calendar.. Can't wait

[bhartwig 18]

<p>I got exciting news yesterday when I went for my 1st education module, as of Monday, BCBS Iowa has ended the 6 month supervised diet requirement!!!! Yay, now I am scheduled to meet with the surgeon on Sept. 4th and I should be able to get sleeved yet this year!</p>

I have BCBS Iowa also, I was told I have the 6 months if diet/exercise counseling. Who can I contact to verify that this is actually still a requirement? It would be great if I could have surgery yet this year ! Any into or advice would be greatly appreciated!

[KatieD6982 68]

OH MY GOSH!!! THANK YOU FOR THIS POST!!!!! I have Highmark and my first appt is today. I was still thinking I would have to do the 6 month supervised diet. YAY!!!!!!!! You made my day!!!

[KatieD6982 68]

Ughhhhh, I went to my first visit this afternoon. According to my doctor's office Highmark BCBS still DOES have the 6 month requirement (also filed under "Highmark Select Blue BCBS") and even if it didn't, this particular doctor's office has a 6 month program. Darnit!! Hopefully I can get everything finished before the six months..... lol.

They did say they would check for an updated policy for BCBS though.

[Eclectick 129]

I have CareFirst BlueChoice (BCBS) our main headquarters is in Maryland, but I am in Florida so It's actually CareFirst Maryland. I had to endure the 6 months with a dietician however it's actually 7 months...I am on my 5th month this week and I was told that a month after your last visit with dietician you then see the doctor and a date is set, once that date is set THEN they submit the pertinent documents to the insurance company...keep in mind, they can STILL deny you.

I am getting nervous, I just found out after the blood test were done that my primary doctor is now considering me diabetic, she also said my hemoglobin was high,(don't know what that means) I haven't had a chance to schedule the follow-up appointment..I currently have SEVERE acid reflux coupled with a hiatal hernia that will be removed during surgery, however with all that being said.......................I am learning to control what I eat, I am definately ready for a life change although the sleeve is only a tool, I consider it a gift...that I will learn to love and cherish for helping me become healthier.

As crazy as it may sound, I even have dreams at night of me being skinny, able to trim my own toe nails, able to sit like an indian again, sitting in a recliner and not have to look at my swelled up feet and most importantly...be able to fit in AND look good in a nice leather jacket when I go riding on my harley.

Nervous but Excited!!

[bhartwig 18]

So excited! Was just told today that BCBS of Iowa has indeed changed their surgery prerequisites. I will be required to have one appointment with a registered dietician, along with a documented history of weight loss attempts. I will not have to complete the 6 months worth of diet & exercise counseling. So, basically, once I have my psych eval done, all other testing completed, and the pre surgery modules required by the bariatric center completed I can have my case submitted for insurance approval. I understand, the whole process could take some time, but I am

Super excited that it's a good possibility I could be scheduled for surgery yet this year ! Keeping fingers & toes crossed!!!

[tlbailey79 1]

Does anyone have any experience with Cigna Insurance? That's who I have and I don't know what their policy is on this subject yet. I just started thinking about getting this done 2 days ago.

[Eclectick 129]

Cigna Pre-approval Requirements

Unless weight loss surgery is specifically excluded from your policy, surgery is covered if the following criteria are met:

The individual is at least 18 years of age or has reached full expected skeletal growth AND has evidence of EITHER of the following:

• A Body Mass Index (BMI) of 40 or greater.
• A Body Mass Index between 35 and 40 with at least one significant comorbidity that may include:
  • Type 2 Diabetes
  • High Cholesterol
  • Heart Disease
  • Pulmonary Hypertension
  • Obstructive sleep Apnea

You must also show that other methods of medically supervised weight loss programs have failed.

The medically supervised weight management program must include monthly documentation of ALL of the following:

• weight
• nutritional program
• exercise program

An evaluation from a bariatric surgeon and your primary care physician with a resulting recommendation for surgery is necessary. A mental health evaluation is required as well as a nutritional evaluation from a physician or registered dietitian.

[vsgchick 117]

Does anyone have any experience with Cigna Insurance? That's who I have and I don't know what their policy is on this subject yet. I just started thinking about getting this done 2 days ago.

I have Cigna. I did a 90 day supervised nutrition program (classes and weigh-ins), psych eval, bloodwork, stress test and a letter from my PCP (must state that the doc recommends *and* medically clears you for surgery). I had no standard comorbidities, but my BMI is over 40. My case was submitted on 8/18 and I was approved 3 days later.

[tlbailey79 1]

I have Cigna. I did a 90 day supervised nutrition program (classes and weigh-ins), psych eval, bloodwork, stress test and a letter from my PCP (must state that the doc recommends *and* medically clears you for surgery). I had no standard comorbidities, but my BMI is over 40. My case was submitted on 8/18 and I was approved 3 days later.

Great. Thank you. I need to get to work then. I haven't even gone to a doctor or anything yet. Thanks again.

[Paris38 2]

I got exciting news yesterday when I went for my 1st education module, as of Monday, BCBS Iowa has ended the 6 month supervised diet requirement!!!! Yay, now I am scheduled to meet with the surgeon on Sept. 4th and I should be able to get sleeved yet this year!

Hi chip305, I also have BCBS

of Iowa and I keep getting told by the insurance coordinator at my doctor's office that I have to have 6 months supervised weight loss attempts. Since I keep telling her that a few of my co-workers have had or are in the process of having the surgery (w/out the 6 months) she is going to submit my paperwork to the insurance company. Did you confirm directly with BCBS their requirements have changed? Looking forward to your reply.

[Paris38 2]

So excited! Was just told today that BCBS of Iowa has indeed changed their surgery prerequisites. I will be required to have one appointment with a registered dietician, along with a documented history of weight loss attempts. I will not have to complete the 6 months worth of diet & exercise counseling. So, basically, once I have my psych eval done, all other testing completed, and the pre surgery modules required by the bariatric center completed I can have my case submitted for insurance approval. I understand, the whole process could take some time, but I am

Super excited that it's a good possibility I could be scheduled for surgery yet this year ! Keeping fingers & toes crossed!!!

Hi. Who told you BCBS

of Iowa changed? I am trying to get my surgery done before the end of the year. Not getting much support from my doctor's office. I feel like I am bothering them with my questions. Great to hear others with the same insurance are not having to do the 6 months.

[chip305 51]

Hi chip305, I also have BCBS

of Iowa and I keep getting told by the insurance coordinator at my doctor's office that I have to have 6 months supervised weight loss attempts. Since I keep telling her that a few of my co-workers have had or are in the process of having the surgery (w/out the 6 months) she is going to submit my paperwork to the insurance company. Did you confirm directly with BCBS their requirements have changed? Looking forward to your reply.

My surgeon's insurance coordinator is the one that told me that the requirement had been dropped, I believe she was contacted by BCBS about the policy change. I really hope this helps you! The surgeon's office is getting ready to submit my case to the insurance company, I will let you know if it goes through.