BCBSNC - SHP: Too good to be true?

[becomingmandikaye 262]

I'm on the NC State Health Plan through BCBS of NC. When I called last month, the consultant told me that there was a requirement of following a medically supervised weight loss program for 3 months.

Turns out - that person was crazy.

I found the Medical Policy (https://www.bcbsnc.com/assets/services/public/pdfs/medicalpolicy/surgery_for_morbid_obesity.pdf) and the requirement WAS 6 months... but it was removed in July of 2014. I called today to confirm.

The only requirements now are when all four of the following requirements are met:

1) Have a BMI greater than or equal to 40 *or* more than 35 with co-morbidities

2) Have no specifically correctable cause for the obesity (e.g. an endocrine disorder)

3) A thorough evaluation has been documented to assess patient's ability to sustain the surgery long term

4) Must be part of a comprehensive pre-surgical, surgical, and post-surgical progam

Is anyone here on the SHP? My concern is that this is too good to be true. Do they evaluate these criteria on a stricter scale now? I would be worried that the "thorough" evaluation is subjective, even though the policy guidelines seem pretty specific (there are 6 criteria for the evaluation).

Could it really be this easy?

[kaitlynm 335]

I think it can be. I have BCBS TX and I just needed one visit with the surgeon, one with the Nut, and one for the phych eval. All plans are different and BCBS is different in different states but my process was pretty easy.