Supervised weight loss for insurance?

[provenzee 262]

I have Anthem BCBS of Virginia and everything seems to be going well. I had my consultation, and first visit with my surgeon already. At that meeting I met with a coordinator who gave me a list of appointments/testing to complete before I see them again in six weeks. The coordinator told me that I am probably going to have the surgery in October or November. I asked the coordinator if I will be required to complete six months of supervised diet before approval, and she said all the insurance requires is to meet with a nutritionist twice within a six week timeframe and that I won't have to. I don't want to get my hopes up, so I was wondering has anyone had experience with Anthem BCBS? It says on their website they require six months. Unless they've accepted my previous attempts at weight loss even though I don't have six continuous months. I'm assuming the insurance coordinator at my surgeons office should know and be correct, right?

[animallover1247 249]

You would assume they know what they are talking about but there's no guarantee. I called my insurance and had them to email me the actually policy regarding the surgery and what the requirements are. If there's a discrepancy in what they say and what the policy says,you can further research it. Good Luck

[Bufflehead 6,358]

Insurance requirements can vary from plan to plan. I have Cigna, but my work has their insurance administered by a separate company with their own requirements, which are completely different from Cigna policies posted on the web. My insurance coordinator knew about that and knew the correct requirements for my specific plan.

You may want to find your member benefit handbook and see what it specifically says about requirements for your plan. If there is a discrepancy between what it says and what your coordinator is saying, bring it to your coordinator and (nicely) ask for clarification. Good luck!

[Nylaj 45]

I would call BCBS Anthem VA & ask them their requirements. Also, write down who you spoke with, last name initial, & if they have a call reference #. Also, look in your Medical Policy book. We just did a BCBS Anthem VA & the patient didn't require a 6 month doctor check.

For Adults

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 (for example, severe obstructive sleep apnea, Pickwickian syndrome, obesity related cardiomyopathy); AND
2. 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
3. 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.

- See more at: http://www.bariatric-surgery-source.com/anthem-blue-cross-blue-shield-weight-loss-surgery.html#sthash.Ct5o3gCK.dpuf

Edited July 26, 2015 by Nylaj