Blue Shield of Ca six month diet

[Chloewithac 0]

I have Blue Shieldnof CA and was denied authorization for bariatric consult because I don't have "documentation of a 6 month diet" Neither my PCP or my medical group or insurance company is being much help. I'm not sure if this means I have to do a physician supervised diet where I weigh in at my pcp for the next 6 months or if it's a diet I can do on my own.

The surgeon program I want to go with had me weigh in at the info session and nutrition session and I have 4 more weigh ins with them before I proceed with their program. My pcp says I don't have to weigh in with her and those weigh ins count but I don't see how that satisfies a 6 month diet if its just weigh ins. Does anyone have experience with this?

[KristenLe 5,979]

@@Chloewithac Talk to your Bariatric Program - I did my supervised diet with the Nutritionist (supervised by surgeon). I have BCBS in another state and they were not forthcoming with what the requirements were either. Your surgeon's office should be able to find out. I didn't need authorization for the Consult - just for surgery.

[Sharon1964 2,530]

Do you have a PPO or an H*M*O*? Blue shied of California removed the 6-month requirement in June of 2015 for PPO plans.

[Chloewithac 0]

I have a hmo. Also it's the authorization for the consult that I need. It's just weird because my pcp said nothing about 6 month diet and said I don't need to come in to weigh with her.

H*m*o

[KristenLe 5,979]

I have a ***. Also it's the authorization for the consult that I need. It's just weird because my pcp said nothing about 6 month diet and said I don't need to come in to weigh with her.

H*m*o

I would say your PCP is incorrect. If you need documentation of 6 months of a supervised diet before seeing the surgeon - she/he needs to be the one to do that. I would talk to the insurance coordinator at your surgeon's office and see if they can help you make sense of the requirements. Good luck!

Edited September 5, 2016 by KristenLe

[Rebecca66 13]

I have CA bcbs HMO and had to do my 6 month diet/visits with my PCP to obtain the referral for the Surgeon. My first visit counted as month 1 so it's really only 5 months. I have my last visit this month. From there she will provide the referral and I will move on to the surgeon who will do the additional testing and submission for the surgery approval.