BCBS 6 month required diet-need advice

[heather113076 0]

Hi everyone! I will have BCBS of Alabama beginning Jan 1, 2008. I know that they require a 6 month medically supervised diet. I was going to go ahead and get started on the diet this month even though I still have UHC insurance. Do you guys think that is ok or will BCBS make me diet from Jan-June? I am also concerned about losing weight while on the diet. I am afraid that if I do the diet and lose 40 or 50 lbs on the diet(I will be doing weight watchers) that BCBS will say "we are denying you for lap band surgery because you have demonstrated an ability to lose weight on your own". Am I being paranoid? Any advice you can give me is appreciated. I have not yet had my consultation with the lap band dr. That day is Jan 16, 2008. I have attended a seminar(Nov 17) and been researching lap band for the last year.

[heyhon63 1]

Thats kind of funny, because I am worried I haven't lost enough weight and they are going to deny me. I don't know If they will count your diet without it being supervised, because that is were the supervised comes in. I have cigna and from what I hear they are very picky. I don't know about bcbs. But to me if they are say a supervised diet that is what they what. One were the dr is weighing you and check what you are eatting taking notes on how you are doing.

[heather113076 0]

I will be going to the dr to have it supervised, I was just wondering if they would count it since I am not yet on BCBS. If I start the diet this month I still have UHC insurance, beginning next month I will have BCBS.

[jacole1820 0]

heather,

i would go ahead and start it now. the sooner the better. by the time your new insurance kicks in, you should be a month into the supervised diet. hope this helps!

ps.....let usknow how it goes! i had to do a 6 month program as well, and tomorrow is my month 5 appt! almost there!

[abeaher 0]

When you switch insurance everything is transferable as far as care you have recieved. For example, aetna requires a 5 year weight loss history in some cases, it does not matter what insurance you had when you had those appointments or what doctor you saw. So if you start now BCBS should honor it, I would just make sure your doc takes BCBS so when you switch over you won't have to switch docs.

Good Luck!!!

[muttsrule 1]

I have BC/BS Carefirst and was told by the doctor I consulted with that they are requiring a six-month supervised UNSUCCESSFUL weight loss attempt. The six months must be consecutive and they will also consider a six-month COMMERCIAL supervised attempt.

My problems are: 1) I can LOSE weight, that isn't the problem. I can't keep it off is the problem. 2) I don't have the funds to support a six-month supervised diet program and insurance doesn't cover it. 3) Even if I had the money, if the goal is to FAIL, what am I supposed to do??? PRETEND to be trying to lose weight?

The whole thing is so incredibly stupid.

[Tamihott 0]

I have BCBS Illinois, and am only on my second month of supervised weight loss and have already lost about 10lbs! Yikes. I do not have a super high BMI so I was worried about that too. I went to the ins website and read their medical policies about the 6 month supervised diet and was relieved that they use the 1st visit BMI. I think the main things are they want to see a change in the way you eat and excercise. What I was told is they want to see that you can stick to life and behavior modifications. My big problem is the 5 years of obesity. I only have 4 where I had "morbid obesity" I did 6 months of Atkins and lost 40lbs so that weight is alot lower than the requirements. I am hoping to slide that one by them!! Good luck everyone Tamara

[gamboagirl 0]

To be safe you better read what your plan says and then call and ask questions, get the call center's person's name and get a log number. Document every conversation you have.

Then make sure your supervising doctor actually accepts your new ins.

It seems like your damned if you do and damned if you don't.

[morningoasis811 1]

In my experience with the Medically supervised diet... it didn't matter what insurance I had. While I was on the diet I had UHC and my Doctor had me come in once a month for check ups (weight, cholesterhol and so on). I kept the same medical group, but switch primary care dr's and insurance, and Healthnet approved my lap band surgery based on my unsuccessful loss attempt ( I lost weight very well, but gained it all back within a year). As long as it's tracked and in your medical record they can use that data.

[reif78 0]

i have himark bc/bs and there idea of a supervised diet is not to have to go somewhere like weight watchers. you do it on your own and then you have the 6 months worth of weight checks with your doctor. your doctor is the one supervising you. .. i honestly didnt adhere to the diet thing i was afraid that the insurance wouldnt approve me if i lost. but yet i never gain stayed at the same weight i think i might have lost a pound the whole six months. hope this helped. i also dont have a problem losing its keeping it off and usually when i lose i alway gain and then some.l hope this help

[kaninag 35]

According to BCBS of Al the 6 month weight loss has to be attempted within a year of submitting for your surgery. I would go ahead and get started. And make sure you go to a good doctor that records everything youre doing to try to lose weight. Yeah insurance company wants you to lose weight so that they can deny you and your surgeon wants you to stay where you are so he can do the surgery. Be careful how much you lose. Because they will deny you. On the surface (paperwise) you do as much as you can to lose the weight!

[kaninag 35]

Oh also, BCBS of AL will take weight watchers etc but you have to be see a dr at the same time! and they have to record it in their notes about you! make sure you see a dietician because they require that as well. lets see am i leaving anything out...oh they also require a psych eval but your surgeon has the option to waive that. if you go to BCBSAL.org and and register....then go to medical policies click on alphabetical and look for surgical management of morbid obesity those papers tell you everything that they require!!! Good luck to ya...and remember they will take their sweet time in approving you

[heather113076 0]

Thanks Kaninag for the info! I am doing WW and I have my first visit with my PCP after the new year. I just got my new insurance cards yesterday so I can go register and read the requirements. I also have a friend that worked for BCBS and I am constantly asking her how they handled things when she was there. Apparently BCBS just recently started covering the Lap Band surgery b/c when she was working there they did NOT cover it. Thanks again for the info!

[JASON R 0]

i also have bcbs of alabama. but mines with the gov. so i guess its the same. but i was told by my lap-band doctor i to do a 7 month diet not the 6 months. so it might have went up.im going the 3rd for the 5th visit and can't wait until i get done with it. i started at 409 and now im at 384. my lap-band doctor wanted me to lose 20 pounds so im good for now.

good luck.

[ebar822 0]

Good luck starting this process! Firstly, even if you're going to do WW, make sure that you have a doctor supervising it monthly (I was told to go every 4 weeks). Secondly, I lost and gained 1-2 pounds every month. It was up two, down two, up one, down three, up three, down two. I basically stayed the same and when I told my surgeon's office about that they said that's EXACTLY what they wanted to see. It kind of depends on how close you are to that BMI of 40 also....if you lose 50 pounds and drop below that BMI, they may not cover you so be careful. Otherwise, losing a few pounds isn't the worst thing that could happen either.

Anyway I would definitely get started soon and I wish you all the best!