BCBS 6 mos diet requirement & comorbidity questions

[SummerShadow 27]

I'm at step one of this process & have my appt with the surgeon next month.... so I'm brimming with questions, concerns, etc... with regards to what insurance requires and what may or may not count. I have BCBS AL.....

My question about the diet thing is this: My Endocrinologist (not my PCP) told me to lose weight (because I'm pre-diabetic) and to follow the plan on a paper she gave me. I went back later, and it wasn't every month because she didn't ask me to do that, and I'd gone from 328 to 280 (was a very restricted diet), and it was literally over 6 mos time from when she told me to follow the plan and when I saw her last (about a month ago) and I'd lost that weight. I know my weight goes up and down because it's unbelievably difficult to stick with such a strict diet when you've not had surgery (for many of us it's difficult anyway).

I wonder if that would count as 6 mos of doctor supervised diet since it was a plan she gave me and I followed? The only thing that didn't happen was monthly weigh-ins with her. She's an hour and a half away so monthly weigh-ins would've been a royal pain but she also didn't require or ask me to come in once a month to weigh in.

Any thoughts?

With regards to comorbidity requirements: My BMI is WAY up there, like 50, so I guess I don't NEED to have a comorbidity of any kind to qualify in that respect, but.. I do have the following and wonder if this helps approval?

Pre-diabetes
Arthritis
HBP (not on medication though)
sleep apnea (Can't use CPAP due to intolerance and causing bruising and pain so use an oral device)
High cholesterol
High Triglycerides
Fatty liver (NASH)
Stroke risk (Had a TIA in 2013, heart ablations in 2014 for AFib, SVT, and Atrial Flutter).

Thanks for your patience with all my questions. I'm having difficulty getting my PCP and my former PCP to get back with me about records showing my weight, BMI etc. I've NO idea what I even need from them but trying to be proactive (suggestions?).

Edited March 2, 2017 by SummerShadow
Clarification

[LeaninLanc 83]

I have BCBS of Minnesota. I had similar questions so I called the BCBS offices and spoke with someone about the six months requirement and also had it emailed to me so I would be fully educated. I think that's a good starting point.

[GMen88 70]

I have Anthem BCBS of CA. During my consultation, my surgeon's office called my insurance to verify that the procedure is covered under my employer plan and then have me the requirements. It was 6 months supervised diet. 40 BMI and over with no co-morbidities will suffice.

I'm not sure if insurance will accept past doctors visits, especially if no weigh ins were included. I suggest you call your insurance directly and ask this specific question. It's better to know then to assume and have wasted your time down the road.

Best of luck!

[SummerShadow 27]

6 hours ago, GMen88 said:

I have Anthem BCBS of CA. During my consultation, my surgeon's office called my insurance to verify that the procedure is covered under my employer plan and then have me the requirements. It was 6 months supervised diet. 40 BMI and over with no co-morbidities will suffice.

I'm not sure if insurance will accept past doctors visits, especially if no weigh ins were included. I suggest you call your insurance directly and ask this specific question. It's better to know then to assume and have wasted your time down the road.

Best of luck!

Thank you. Insurance companies are so fickle and vastly different from one kind and state to the next. But, I guess once I have that first appointment I'll get some pointers, hopefully, on what to do on my end next. I was hoping the diet that my Endo put me on would count as I just got a weigh in a couple of weeks ago. Maybe with it being that close, who knows? Or, I may have to start from scratch and wait 7 months.

[Lakenya 0]

I have BCBS IL and per the doctors office they require proof of previous weight loss attempts like Weight Watchers or something similar. And I've done that program so long ago. I don't have record of a lot of stuff I tried because I wasn't thinking about surgery in my 20's. But my question is did anyone else have to show proof and what did you provide for approval?

[chryss 61]

I have BCBS and I was told that it has to be six consecutive months of meeting with a doctor or Registered dietician. At the appointment the doctor/RD has to record your weight and blood pressure. They also have to supply notes from each visit of what diet and nutrition they discussed with you. My endocrinologist did this for me for 2 months and then I switched to a Bariatric nutritionist.

[SummerShadow 27]

1 hour ago, chryss said:

I have BCBS and I was told that it has to be six consecutive months of meeting with a doctor or Registered dietician. At the appointment the doctor/RD has to record your weight and blood pressure. They also have to supply notes from each visit of what diet and nutrition they discussed with you. My endocrinologist did this for me for 2 months and then I switched to a Bariatric nutritionist.

Guess I'll be starting from scratch. :/ BC/BS of AL requires 7 months. I'm not going to be using my PCP or Endo if I have any say about it. I suppose I'll ask for a bariatric nutritionist from the get-go. Going to be a looooooooooooonnnng 7 months.

[paradise 19]

I also have BCBS of Alabama. I am on month 6th of the 180 days. You can call them and have them email you the requirements.

[paradise 19]

https://drive.google.com/file/d/0B73DOAhSLctjMXZLM0FhdDc2VlE/view?usp=drivesdk

[OutsideMatchInside 10,166]

I used BCBSIL when I had surgery and they didn't require 6 months of anything if your BMI was high enough, and I think that was anything over 40. I went from first visit to surgery in 8 weeks.

[Middus 491]

I'm at step one of this process & have my appt with the surgeon next month.... so I'm brimming with questions, concerns, etc... with regards to what insurance requires and what may or may not count. I have BCBS AL.....
My question about the diet thing is this: My Endocrinologist (not my PCP) told me to lose weight (because I'm pre-diabetic) and to follow the plan on a paper she gave me. I went back later, and it wasn't every month because she didn't ask me to do that, and I'd gone from 328 to 280 (was a very restricted diet), and it was literally over 6 mos time from when she told me to follow the plan and when I saw her last (about a month ago) and I'd lost that weight. I know my weight goes up and down because it's unbelievably difficult to stick with such a strict diet when you've not had surgery (for many of us it's difficult anyway).

I wonder if that would count as 6 mos of doctor supervised diet since it was a plan she gave me and I followed? The only thing that didn't happen was monthly weigh-ins with her. She's an hour and a half away so monthly weigh-ins would've been a royal pain but she also didn't require or ask me to come in once a month to weigh in.
Any thoughts?
With regards to comorbidity requirements: My BMI is WAY up there, like 50, so I guess I don't NEED to have a comorbidity of any kind to qualify in that respect, but.. I do have the following and wonder if this helps approval?
Pre-diabetes
Arthritis
HBP (not on medication though)
 sleep apnea (Can't use CPAP due to intolerance and causing bruising and pain so use an oral device)
High cholesterol
High Triglycerides
Fatty liver (NASH)
Stroke risk (Had a TIA in 2013, heart ablations in 2014 for AFib, SVT, and Atrial Flutter).

Thanks for your patience with all my questions. I'm having difficulty getting my PCP and my former PCP to get back with me about records showing my weight, BMI etc. I've NO idea what I even need from them but trying to be proactive (suggestions?).

My BCBS didn't require anything more than BMI > 40 or 35-40 with co morbidity.
Your Endocrinologist's diet should count as a supervised diet.
I was only asked if I had attempted dieting before.. (my surgeon also had me lose a minimum of 10lbs before meeting with me to discuss surgery)

[Middus 491]

I'm at step one of this process & have my appt with the surgeon next month.... so I'm brimming with questions, concerns, etc... with regards to what insurance requires and what may or may not count. I have BCBS AL.....
My question about the diet thing is this: My Endocrinologist (not my PCP) told me to lose weight (because I'm pre-diabetic) and to follow the plan on a paper she gave me. I went back later, and it wasn't every month because she didn't ask me to do that, and I'd gone from 328 to 280 (was a very restricted diet), and it was literally over 6 mos time from when she told me to follow the plan and when I saw her last (about a month ago) and I'd lost that weight. I know my weight goes up and down because it's unbelievably difficult to stick with such a strict diet when you've not had surgery (for many of us it's difficult anyway).

I wonder if that would count as 6 mos of doctor supervised diet since it was a plan she gave me and I followed? The only thing that didn't happen was monthly weigh-ins with her. She's an hour and a half away so monthly weigh-ins would've been a royal pain but she also didn't require or ask me to come in once a month to weigh in.
Any thoughts?
With regards to comorbidity requirements: My BMI is WAY up there, like 50, so I guess I don't NEED to have a comorbidity of any kind to qualify in that respect, but.. I do have the following and wonder if this helps approval?
Pre-diabetes
Arthritis
HBP (not on medication though)
 sleep apnea (Can't use CPAP due to intolerance and causing bruising and pain so use an oral device)
High cholesterol
High Triglycerides
Fatty liver (NASH)
Stroke risk (Had a TIA in 2013, heart ablations in 2014 for AFib, SVT, and Atrial Flutter).

Thanks for your patience with all my questions. I'm having difficulty getting my PCP and my former PCP to get back with me about records showing my weight, BMI etc. I've NO idea what I even need from them but trying to be proactive (suggestions?).

My BCBS didn't require anything more than BMI > 40 or 35-40 with co morbidity.
Your Endocrinologist's diet should count as a supervised diet.
I was only asked if I had attempted dieting before.. (my surgeon also had me lose a minimum of 10lbs before meeting with me to discuss surgery)

[Middus 491]

I'm at step one of this process & have my appt with the surgeon next month.... so I'm brimming with questions, concerns, etc... with regards to what insurance requires and what may or may not count. I have BCBS AL.....
My question about the diet thing is this: My Endocrinologist (not my PCP) told me to lose weight (because I'm pre-diabetic) and to follow the plan on a paper she gave me. I went back later, and it wasn't every month because she didn't ask me to do that, and I'd gone from 328 to 280 (was a very restricted diet), and it was literally over 6 mos time from when she told me to follow the plan and when I saw her last (about a month ago) and I'd lost that weight. I know my weight goes up and down because it's unbelievably difficult to stick with such a strict diet when you've not had surgery (for many of us it's difficult anyway).

I wonder if that would count as 6 mos of doctor supervised diet since it was a plan she gave me and I followed? The only thing that didn't happen was monthly weigh-ins with her. She's an hour and a half away so monthly weigh-ins would've been a royal pain but she also didn't require or ask me to come in once a month to weigh in.
Any thoughts?
With regards to comorbidity requirements: My BMI is WAY up there, like 50, so I guess I don't NEED to have a comorbidity of any kind to qualify in that respect, but.. I do have the following and wonder if this helps approval?
Pre-diabetes
Arthritis
HBP (not on medication though)
 sleep apnea (Can't use CPAP due to intolerance and causing bruising and pain so use an oral device)
High cholesterol
High Triglycerides
Fatty liver (NASH)
Stroke risk (Had a TIA in 2013, heart ablations in 2014 for AFib, SVT, and Atrial Flutter).

Thanks for your patience with all my questions. I'm having difficulty getting my PCP and my former PCP to get back with me about records showing my weight, BMI etc. I've NO idea what I even need from them but trying to be proactive (suggestions?).

My BCBS didn't require anything more than BMI > 40 or 35-40 with co morbidity.
Your Endocrinologist's diet should count as a supervised diet.
I was only asked if I had attempted dieting before.. (my surgeon also had me lose a minimum of 10lbs before meeting with me to discuss surgery)

[Middus 491]

I'm at step one of this process & have my appt with the surgeon next month.... so I'm brimming with questions, concerns, etc... with regards to what insurance requires and what may or may not count. I have BCBS AL.....
My question about the diet thing is this: My Endocrinologist (not my PCP) told me to lose weight (because I'm pre-diabetic) and to follow the plan on a paper she gave me. I went back later, and it wasn't every month because she didn't ask me to do that, and I'd gone from 328 to 280 (was a very restricted diet), and it was literally over 6 mos time from when she told me to follow the plan and when I saw her last (about a month ago) and I'd lost that weight. I know my weight goes up and down because it's unbelievably difficult to stick with such a strict diet when you've not had surgery (for many of us it's difficult anyway).

I wonder if that would count as 6 mos of doctor supervised diet since it was a plan she gave me and I followed? The only thing that didn't happen was monthly weigh-ins with her. She's an hour and a half away so monthly weigh-ins would've been a royal pain but she also didn't require or ask me to come in once a month to weigh in.
Any thoughts?
With regards to comorbidity requirements: My BMI is WAY up there, like 50, so I guess I don't NEED to have a comorbidity of any kind to qualify in that respect, but.. I do have the following and wonder if this helps approval?
Pre-diabetes
Arthritis
HBP (not on medication though)
 sleep apnea (Can't use CPAP due to intolerance and causing bruising and pain so use an oral device)
High cholesterol
High Triglycerides
Fatty liver (NASH)
Stroke risk (Had a TIA in 2013, heart ablations in 2014 for AFib, SVT, and Atrial Flutter).

Thanks for your patience with all my questions. I'm having difficulty getting my PCP and my former PCP to get back with me about records showing my weight, BMI etc. I've NO idea what I even need from them but trying to be proactive (suggestions?).

My BCBS didn't require anything more than BMI > 40 or 35-40 with co morbidity.
Your Endocrinologist's diet should count as a supervised diet.
I was only asked if I had attempted dieting before.. (my surgeon also had me lose a minimum of 10lbs before meeting with me to discuss surgery)

[Middus 491]

I don't know why Briatric pal posted my response 1 million times though