FL Anthem BCBS 6 month req HELP! :-)

[mbone05 1]

Not sure if anyone can give me advice on this one. I am just starting the process. I have been working with my dr on a dietary plan since September of last year. Here is my problem, I have dr visits in Sept, Oct, Nov, Jan, Feb and April but since I did not go in December and March the office I contacted believes I will have to start the process all over again for my 6 month weight loss. I find that ridiculous. Can anyone help me with this or give me some advice?

Thank you all!

Edited May 14, 2018 by mbone05
Wanted to add help

[SleeveinIL 386]

I know that my office had 3 months of visits prior and they had to be completed by certain dates. I remember I had to move around some work meetings to accommodate the last date. I am sure the rules are determined by the insurance and each one makes up their own set of guidelines. Have you had a change to call your insurance and ask them what they require? It might be helpful.

[mbone05 1]

Yes, I called them and they sent me the guidelines this is how it is worded.

The individual must have serially documented active participation in a non-surgical weight reduction regimen for at least 6 continuous months, in the 2 years prior to surgery, to enable both behavioral changes and adequate assessment of anticipated postoperative dietary maintenance. These efforts must be fully appraised and documented by the physician requesting authorization for surgery.

The coordinator advised that there can't be any missed months. I just hate to start from the beginning.

[ewms 57]

Did you happen to see your pcp during those missed months? That may be able to count.

[Briswife15 890]

I also have Anthem BCBS, and doctors office says I need yo see a hospital based nutritionist every month for 6 months. My plan wording is the same as yours. I interpret it as needing to be continuous. No breaks. Unfortunately you may have to go back to April and start your 6 months there. :-(

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[mbone05 1]

Thank you all for your help. I guess I was just hoping. I did see my primary care but not in the months of absence. :-(

[newmebithebypass 713]

Yep unfortunately it is 6 consecutive months zero breaks my program stresses this if you miss a month you start over from when it became consecutive again and for my bcbs it is 7 total because the first meeting with the surgeon don't count

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[KatallacStrong 49]

OMG I am in the exact same situation; every other month I went ugh. My doc is going to contact my insurance (Anthem BCBS and I’m in MO) see what he can do because he believes I have done more than the required 6 months non-surgical weight-loss regimen.

Lol I posted this same question in the pre-op Q&A section. I am new to this so I didn’t even see a insurance section until just now. Once I hear from my doc I will follow-up with you:)

[lviz 6]

Kat any feedback? I have 5 consecutive months, doctors office cancelled my April appt and I didn’t know I needed 6. Totally freaking out as today was 30 days for ins to respond and they haven’t

[KatallacStrong 49]

[KatallacStrong 49]

[KatallacStrong 49]

On 07/02/2018 at 21:53, lviz said:

Kat any feedback? I have 5 consecutive months, doctors office cancelled my April appt and I didn’t know I needed 6. Totally freaking out as today was 30 days for ins to respond and they haven’t

I went to my apt and my doc is going to consider April as an apt since a directive was given and a weight was recorded. If your doc cancelled tour apt did y’all discuss anything that may have been recorded? I am counting my blessings they are counting April as an apt, but if yours doesn’t I would challenge it since they’re the ones who cancelled.

[lviz 6]

i finally got approved. They took the whole 30 days, and didn't update my surgeon until business day 31. I'm sooooo excited and nervous!