BCBS MS Sleeve

[aHealthierMe121714 27]

Does anyone have BCBS of Mississippi as a state employee? My 6 mo. will be up 12/5, I have EGD & psych. eval. on 11/25. Already met with surgeon and even have my follow up appt. & surgery date sched. Praying ins. approves on time. Anyone know how long it normally takes or how long it took you?

[GenaW828 117]

I have BCBS of TN under my husband and he works for the school board. they submitted my information on 11-7 I got a call on the following Tuesday that it was approved. I thought that was awfully fast because I use to work for an insurance company and they took weeks to get stuff approved.

[Heather Barth Williams 2]

I'm a BCBS MS State employee and I'm just starting on this journey. I'm attending a seminar on May 13th, so I'm interested in your experience with all this. Any advice would be great! Do you have to have 6 months on a diet?

[bkloyd 0]

I have BCBS of TN and a state employee. I've finished jumping thru all of the hoops (I hope) and waiting on approval. Never really new what their requirements were for approval. My BMI is 37-38 with co-morbidities. Any info would be appreciated.

[Mistie 201]

Greetings! I'm BCBS MS (state employee) and just starting. I found out our insurance now pays (started in fall 2013), completed the online educational seminar the same day (I was going to book the in-person, when I found they added the online portion), and attended the in-person support group the same week. The next week I scheduled the appointment - the earliest they could get me in is May 27th. I called today to see if there had been any cancellations, and I was moved up to May 4th - VERY EXCITED!

I have spoken with BCBS, as well as Active Health - who manages that portion of our insurance. I wanted to know specifics of our requirements for approval. According to Active Health we have the three options (and it's in our manual we can find online) - 6 months of a distance supervised program through them, two three-month physician supervised programs, or a three month supervised program through our bariatric center (this is not the wording in the program, rather, layman's terms for it!). They do not have a requirement that we lose weight, rather, that we show we participated in the program.

If you go to MyAccessBlue, you can find your 2015 manual under publications - the info on bariatric procedures is on page 20 something. Be forewarned - the formatting is REALLY off, so it took me awhile to make sense of it, that it was ONE of the options, not all! Ha.

[Heather Barth Williams 2]

Okay I looked but didn't see the part that says we could just do a 3 month supervised program through our bariatric center BUT if that's indeed the case that would be GREAT!!!

[Mistie 201]

Heather,

The specific info is on pages 20-22, under covered services.

On pages 21 and 22 is where it talks about the requirement for a supervised diet. As I said, their bullets are really mixed up! The levels are screwy, so it's hard to tell what's a requirement, and what's an 'option.' I'll post it below for you!

Number 1: two programs which have been supervised by other doctors, takes a total of 6 months.

Number 3: Supervised by Active Health - takes 6 months - just phone calls.

Number 2 can be completed through your bariatric center. Takes 3 months. Includes visits with the physician and a nutritionist. The center said our insurance will NOT cover the nutritionist, however.

The exact wording is below!

*Member must meet 1 or more of the following criteria (1) physician-supervised nutrition and exercise program; or (2) multidisciplinary surgical preparatory regimen, or (3) Participation in the Weight Management Enhancement Program.

(1) Physician-supervised nutrition and exercise program (it's just listed as a sub-bullet, not numbered, so hard to tell the difference) - Member has participated in two (2) or more physician-supervised nutrition and exercise program (including dietician consultation, low calorie diet, increased physical activity, and behavior modification, Weight Watchers, the Atkins Diet, the South Beach Diet, or Sugar Busters), documented in the medical record at each visit. The physician-supervised nutrition and exercise program must meet ALL of the following criteria: (IE. This is two, three month programs at least - so this requires at least 6 months to complete).

(2) Multidisciplinary surgical preparatory regimen: Within 6 months prior to surgery, the participant must participate In organized multidisciplinary surgical preparatory regimen of at least three months (90 days) duration meeting ALL of the following criteria, in order to improve surgical outcomes, reduce the potential for surgical complications, and establish the participants ability to comply with post-operative care and dietary restrictions:

• Behavior modification program supervised by qualified professional
• Consultation with a dietician or nutritionist
• Documentation in the medical record of the member's participation in the multidisciplinary surgical preparatory regimen at each visit (A physician's summary letter, without evidence of contemporaneous oversight, is not sufficient documentation. Documentation should include medical records of the physician's initial assessment of the member, and the physician's assessment of the member's progress at the completion of the multidisciplinary surgical preparatory regimen).
• Exercise regimen (unless contraindicated) to improve pulmonary reserve prior to the surgery, supervised by exercise therapist or other qualified professional.
• Program must have a substantial face-to-face component (and must not be entirely delivered remotely).
• Reduced-calorie diet program supervised by dietician or nutritionist.

(3) Participation in the Weight Management Enhancement Program for 6 months (This is the Active Health program - monthly phone calls).

Active Health administers our weight management and smoking cessation programs. The telephone number for more information from them directly is 866-939-4721. They were very helpful when I called!

[Heather Barth Williams 2]

Thanks Mistie! I knew the bullets seemed off in their formatting. Wow, that's EXCITING! That means I could potentially have surgery as early as September. You've made my day! THANKS!!!!!!!!!!

[chickalafe 3]

_{Misti - I'm the same person as Heather Barth Williams but to get on the mobile app I had to create a second account (which I'm trying to get the 1st deleted)}

_{Dietitian Services}

_{Dietitian services are limited to a maximum of four (4) visits per participant during a calendar year. One (1) dietitian visit per year is provided at no cost to the participant under wellness/preventive benefits when a participating dietitian renders services. Three (3) additional visits will be covered subject to the appropriate calendar year deductible and coinsurance amounts.}

[aHealthierMe121714 27]

I was BCBS of MS state employee and I had to do 6 mo My Active Health where they call me 1x per month. In the mean time I was making calls to bariatric center where my surgeon was and setting 1st appt at 4 mos with him. They day I had my 6 mos phone call I turned arouNd, called my surgeons office who took care of all my insurance finagling, that was Fri and Mon she called and I was approved. Had surgery 2 weeks later (bc had to do the 2 wk clear liquid pre-op diet). Been amazing ever since. Pre-op weight on 12/29/14 was 254.8 and TODAY (4/22/15) I am 204.6 and I feel AMAZING! Great luck to you and if you have any questions I will try to keep check and respond. I haven't been in on a while.