Anthem BCBS 6 Months Pre-Op Diet

[TheHealthyPrepster 4]

Hey everyone,

I'm just a little worried about the 6 months of pre-op dieting. According to my hospital's insurance specialist, some insurance providers are now denying people if they don't lose a pound per month or even gain weight during their 6 months of pre-op dieting. I've completed 6 months of dieting, however I did gain weight and lose weight irregularly. I'm currently a professional student living about 600 miles away from my surgeon so I'm just trying to make sure I get everything done & keep to my tight schedule!

Is there anyone with Anthem BCBS that can offer a little insight on what is expected?

Thanks!

[Aworknprogress 35]

I have BCBS as well I'm also doing the 6 month weightloss plan I wasn't told anything like that I think they expect for our weight to fluctuate...I'm only about to be on month 5 come January.But as long as you have done everything you were told everything else should fall into place and you should get your approval.I'm worried about the approval process as well but I just been trying to stay positive about the whole situation...goodluck

[TheHealthyPrepster 4]

Great! thank you

[BrownsugarNY 30]

I have BCBS and I was approved within 24 hours and I gained a whopping 5 LBs my 5th month in my pre-op appointments.

Don’t worry so much they look at initial weight as a factor for approval and you can call the insurance company to get very specific details of what you’re required to do to ensure you get approved.

Not sure what your company wants by my BCBS NY only wanted psych evaluation, 6 months of PCP weigh-ins and medical clearance from primary physician and like I said my approval was completed with 24 hours and I was sleeved 1 week ago 12/22

HW: 232 SW: 225 CW: 215
5’3”

[Brittanyblue 55]

I have BCBS MN, and they told me at the beginning as long as I am the same weight or less on the final meeting then you’ll be fine. If you gain weight before your surgery they said it could get postponed but I think that’s only if you gain weight on the pre op diet.

[Brittanyblue 55]

I also gained 10 lbs within my 6 months of visits but I lost it all before the meeting with the surgeon and was fine [emoji5]

[TheHealthyPrepster 4]

23 hours ago, BrownsugarNY said:

I have BCBS and I was approved within 24 hours and I gained a whopping 5 LBs my 5th month in my pre-op appointments.

Don’t worry so much they look at initial weight as a factor for approval and you can call the insurance company to get very specific details of what you’re required to do to ensure you get approved.

Not sure what your company wants by my BCBS NY only wanted psych evaluation, 6 months of PCP weigh-ins and medical clearance from primary physician and like I said my approval was completed with 24 hours and I was sleeved 1 week ago 12/22

HW: 232 SW: 225 CW: 215
5’3”

congrats on getting sleeved so quickly!!!

[TheHealthyPrepster 4]

21 hours ago, Brittanyblue said:

I have BCBS MN, and they told me at the beginning as long as I am the same weight or less on the final meeting then you’ll be fine. If you gain weight before your surgery they said it could get postponed but I think that’s only if you gain weight on the pre op diet.

That's exactly what I needed to hear! I'm hoping to knock out the holiday weight gain before my final weigh in.

[Daily Encounter 16]

On 12/25/2017 at 7:26 PM, TheHealthyPrepster said:

Hey everyone,

I'm just a little worried about the 6 months of pre-op dieting. According to my hospital's insurance specialist, some insurance providers are now denying people if they don't lose a pound per month or even gain weight during their 6 months of pre-op dieting. I've completed 6 months of dieting, however I did gain weight and lose weight irregularly. I'm currently a professional student living about 600 miles away from my surgeon so I'm just trying to make sure I get everything done & keep to my tight schedule!

Is there anyone with Anthem BCBS that can offer a little insight on what is expected?

Thanks!

I have Anthem BCBS and also had the 6 months of medically supervised weight loss. Anthem BCBS did not require me to lose a certain amount of weight nor did they advise that I could not gain weight. In fact, during the 6 months I'd lost about 6lbs and then gained 4 of it back. However, of the 4 I gained, I lost 3 of that when my paperwork was submitted. I was approved the exact same day. I had Gastric Bypass on December 18th.

[jlprn56 0]

I have Anthem BCBS also and on month 4 of 6 - lost 8 pounds. How long after you completed the 6 months was your surgery scheduled?

[Brittanyblue 55]

I have Anthem BCBS also and on month 4 of 6 - lost 8 pounds. How long after you completed the 6 months was your surgery scheduled?

After my 6 months was done, they scheduled me to meet with the surgeon that week. Then the day you meet with the surgeon you schedule your surgery. The whole process for me only took about 3 weeks.

[survive.sleeve.slay 31]

I have BCBS and I was approved within 24 hours and I gained a whopping 5 LBs my 5th month in my pre-op appointments.

Don’t worry so much they look at initial weight as a factor for approval and you can call the insurance company to get very specific details of what you’re required to do to ensure you get approved.

Not sure what your company wants by my BCBS NY only wanted psych evaluation, 6 months of PCP weigh-ins and medical clearance from primary physician and like I said my approval was completed with 24 hours and I was sleeved 1 week ago 12/22

HW: 232 SW: 225 CW: 215
5’3”

I wish this was the case for me. I have BCBS Anthem NY. I did my 6 months, all losses, got my evals and everything. My paperwork was sent to them 1/5/18. I've called EVERY day and as of this morning, 1/15/18 it is still "pending". I'm so aggravated!

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[Sadiebug 206]

I had Anthem BCBS and didn't have a requirement to lose anything - but my surgeon had a requirement that we couldn't gain. I think I lost maybe 6-8 lbs over the 6 months but I did have at least one month with a gain. I was approved farily quickly (about 2 weeks). It might also depend on how your physician/program writes it up. I had to submit food and exercise logs for the whole 6 months for my program so going into it they clearly were showing that I had given it a good effort. Not saying that makes an approval guaranteed - but my program certainly went overboard with the paperwork they sent in to Anthem.

[survive.sleeve.slay 31]

I had Anthem BCBS and didn't have a requirement to lose anything - but my surgeon had a requirement that we couldn't gain. I think I lost maybe 6-8 lbs over the 6 months but I did have at least one month with a gain. I was approved farily quickly (about 2 weeks). It might also depend on how your physician/program writes it up. I had to submit food and exercise logs for the whole 6 months for my program so going into it they clearly were showing that I had given it a good effort. Not saying that makes an approval guaranteed - but my program certainly went overboard with the paperwork they sent in to Anthem.

I got my approval on January 15th! Now I'm awaiting clearance from the pulmonologist because of cpap compliance. I have insomnia so some nights I would take it off before I hit the 4 hour mark and all that is counting against me, which I had no idea about. I have an extremely mild case of apnea. .5 or less "incidents" per night, yet I'm stick waiting to schedule while he's out on vacation. [emoji35]

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[Sadiebug 206]

25 minutes ago, survive.sleeve.slay said:

I got my approval on January 15th! Now I'm awaiting clearance from the pulmonologist because of cpap compliance. I have insomnia so some nights I would take it off before I hit the 4 hour mark and all that is counting against me, which I had no idea about. I have an extremely mild case of apnea. .5 or less "incidents" per night, yet I'm stick waiting to schedule while he's out on vacation.

Sent from my SM-G950U using BariatricPal mobile app

Congratulations!!! It's such a huge step Hopefully your pulmonologist comes back from vacation soon and gives you clearance!