Insurance Co. requires 6 months of documented medically supervised wght loss plan

[carol422 0]

At a nutrition class I attended everyone wanted to know "what if I lost too much weight?". The nurse told us they go your bmi from the first visit and no one from their office has ever lost too much weight. Good Luck, we are all in this together!

[honynbaby 0]

I have Great-West Ins. and they also require you to do a 6mo. documented physician supervised weight lose plan. They also want documentation on all other weight lose programs you have been on. But I'm still confused on exactly what all they're wanting.

So if anyone has Great-West and can give me some info., I'd really appreciate it.

I'd also like to know how much it helps your chances on being approved when there are other medical issues involved. And your other doctors highly reccomend you have this surgery.

Any info anyone has would be great.

Thank You,

Tammy

[shanzmac 0]

I have Cigna and do you know they told me to make sure submit pictures of myself???

I was a bit confused so I said it back to her..."pictures'? and she said yes mam.

I then could not help myself and asked what she would like me to wear in in the pictures....something black and lacey???

She didn't think that was funny at all.

[Freebird 0]

I have Cigna also and nothing has been said, nor can I find it in their "qualification" list about needing pictures. I would call again if I were you and I bet you get a different answer. Good luck.

[Forestcat5 1]

I have cigna and they didn't ask for pictures....I agree with Freebird - call them again.

Forestcat

[Big Fred 0]

I know many people that have Cigna and no one had to submit pictures not even myself. I agree, I would call and ask again.

I believe that there also may be a privacy issue, double check with your PCP.

I was finally approved, but had to jump through the six month documentation hoop. Please make sure you document everything, the psych visit, monthly PCP visits, excersise program, everything! Believe me it will help in the end.

Good luck on your journey.........

[shanzmac 0]

Oh, they are not getting pics:omg:!!!!! I just thought it was odd.

Here is the list per Elizabeth w/Cigna:

All medical records

test results

lab results

weight/height/BMI

Meds I'm on

Family health history

treatment plans for weight loss

blood pressure

photos

exact CPT codes

evalutaion by PCP/Surgeon/Psych/Nutritionist

must take part in a 26 week Professionally supervised weight loss program.

Look, I know the lady is completley wrong for asking me for photos but she really did say it.

[hope2bhealthy 2]

donnajade - I have Cigna also and I am worried that I am not doing enough as far as the diet and exercise goes. I've talked to the cust. serv. rep at cigna, and she seemed to think that simply going to the doctor every month and having my vitals recorded was enough. did you write down everything you ate, or keep an exercise log? I don't want to make 6 months (4 to go) and then have them be hard asses on me.

[Cota129 0]

I have Blue Advantage which is part of bcbs/IL. They used to require 6 mos. of supervised dietician visits, but recently changed it to 12 mos. They also reserve the right to require 12 more mos. Also, they require that you have co-morbidities. I have a BMI of 47.3. Amazingly, that is not enough to qualify for surgery. Thankfully, I don't have high cholesterol, high BP, or diabetes. I am also considered too healthy to be considered at this time :faint: I decided that at my current age of 50, I did not want to wait for 12-24 months to have surgery and possibly develop an illness. I got a loan and am paying for the surgery myself. My date is 11/8/07. The other irony is that I can get my excess stomach skin removed at 100% insurance coverage, and possibly get my breasts lifted, because BCBS recognizes that there are health risks, such as skin infections, from sagging, folded skin . So my thought is, I pay for the surgery myself, but in 2 years I'll have a flatter tummy and nice breasts courtesy of my insurance.

[mayadurga 1]

Good question. I called my insurance about the 6 month waiting period/documented weight loss before qualifing for the surgery. Interesting because the insurance customer service rep got banded 3 months ago. She said the insurance looks at the beginning BMI at the 1st Dr. visit and it is OK if BMI drops alittle below 40. Hopefully this is the same for your insurance. good luck. m

[Donnajade 0]

Hope2B - I saw my PCP every month like clockwork. They recorded my weight, BP & pulse. When my Dr. came in he would look things over, ask how my exercising was going - I was trying to walk for 30 minutes every other night and this is what I told him each time. (I did sprain my ankle during this time which I had the documentation from the hospital so I didn't walk for 3 weeks), I was signed up for an automatic deduction from my back account for Weight Watchers and was trying to follow that program. I didn't lose one pound during the six months. I talked to the rep at Cigna numerous times during those six months with the same questions as you - "am I doing everything right, do I need to do more" and so on. When I sent my info to my surgery Dr. I included copies of my bank statements where it showed the deduction for Weight Watchers - I have no idea if that helped or not. I really think it has a lot to do with who your employer is. We have Cigna through my husband's work and he works for a large company. Every time I called Cigna I wrote down my questions before I got a rep and then I wrote down the rep's name and their answers to my questions. Make sure your PCP is documenting that you are doing a healthy eating program, exercising and so on. I think I've read on here that some people kept a journal of their food and exercise - I'm sure it would be good to have.

I know I'm rambling - I'm just trying to remember all the stuff. I hope I've helped. My surgeon told me just Monday that he knows one important thing with Cigna is to make sure you don't miss a month's visit. That was something he had been told from other patients. Shoot me a note if you have any questions - I'll do my best to help. Good luck.

[::Lori:: 0]

I also had to do the 6 month supervised diet before my insurance would approve me. I had just qualified with the 40 BMI at the start of the 6 months. So I worked to maintain, not lose the weight.. so i would still qualified when we resummited the paperwork again. I was surprised how quickly the 6 months flew by. Now I am a week Post Op and 15lbs lighter. It was worth the time, considering some insurance companies don't pay at all.

[tweety63 0]

I have hmo bcbs and have been doing the 12 months supervised diet they require. My bmi is now 39 does that mean now the won't cover my surgery. They require a full 12 months. I will be so mad if after 12 months of waitng all this ins. stuff is crap. Did this happen to anybody. I will be done with my 12 months in Dec.

[tweety63 0]

Did anyone go below 40 bmi after 1 year of dieting? Then get rejected, for being under the 40 bmi. Thanks for the imput.

[Pnw_Red 2]

HI all, I'm just starting my six months of supervised diet/exercise program. I've been on Jenny Craig for a couple months, but nothing very documented.

My policy info (BC/BS of IL ) specifically says that that BMI at the BEGINNING of the weight loss program is the qualifying number, and even has a paragraph that states that most people can manage to lose some weight and stick to a program for six months but after that point, it generally tapers off and/or weight gain starts. So, the policy certainly doesn't read like they're trying to "trick" people into losing too much weight to qualify.

I couldn't find any info online in the patient section, but once you go to the health care provider section, it's pretty easy to find policy info.

For those of you who knew of the 6 month requirement, how did you handle it? Did you just start the six month program and try to get surgery at the end, or did you check with the insurance company at the beginning and meet with the surgeon immediately, then start on the six months?