BCBS of AL 6-month diet question

[Southern Missy 1]

Hi All,

I am trying to figure out every way possible to get this surgery ASAP so here is the deal...

I started seeing my physician in October but I had been attending Weight Watchers WEEKLY since April, with september being my last month. Do you think there is a way to get them to use that as my supervised diet if I had my physician verify that I was on a diet plan????

It really just hit me that I had done it for the 6 months prior to starting with my physician. Anyway, if you have any ideas, suggestions, general knowledge about it, I would certainly appreciate it!!!

[snuffy65 1]

I jsut talked with my doc's office and they asked me if I went to weight watchers, caus ethey could use that as a documented 6 months diet.

hope that helps.

BTW: I got BCBS of Michigan

[Southern Missy 1]

YEA!! Thanks Snuffy, for your reply. That's the answer I was looking for. :tongue:

Anyone else have any experience with this -- good or bad??

[Rocket City Guy 0]

but I think I've seen something from BC/BS saying that as long as you have the documentation, Weight watchers or Jenny Craig or similar programs can substitute for a Dr. supervised diet. I will look around to see if I can find that piece of paper that says that...I think I got it in the packet from the seminar I attended at St. Vincents East (Drs Miles and Schmitt). Also, you could probably just call BCBS and ask. Hope this helps and that it works for you!

[Southern Missy 1]

RCG.. I think I'm in love!! :cool: JUST KIDDING!!!

Seriously, though, I have a packet from the Miles/Schmitt seminar so I'll check it out and see. I did sit down yesterday and write a letter for my PCP and included those dates. I was going to take it in to the office next week and see if they will use it and have him sign it. It just makes me feel like it will get me there a lot sooner if I do most of the work for them. :thumbup:

Thanks again for your response. I was a little bummed because they canceled a seminar I was supposed to attend yesterday morning due to the weather so it was a pick-me-up (thus, the whole declaration of love thing )

[wrestlersmom 0]

I have BCBC AL and if your Dr's will state that you have been on a diet for 6 months he has to document every time you went in for a weight check then it will work.. But BCBS AL will not take weight watchers as a subsitute for the 6 months Dr's visits.. Here below are the by laws...

Notice the words that are in BOLD...... RE read it..Sometimes it takes a few times to understand.... Hope this helps....

1. BMI of 40 or greater, or BMI of 35 or greater with co-morbid conditions including

but not limited to HTN on optimal drug therapy, cardiovascular disease, diabetes

(must be treated with insulin or oral agents), pulmonary hypertension, or severe

obstructive sleep apnea. (RDI of 50 or greater). (NIH, 1998 and American Society

for Bariatric Surgery). For BMI calculation see

Redirect Page.

2. The condition of morbid obesity (BMI ≥ 40 or BMI ≥ 35 with presence of comorbid

conditions) must be of at least 5 3 years duration. There must be documentation in

medical records by a primary care or attending physician of patient height and weight

for the past 3 years. A letter from the primary care physician and dated photographs

will be considered in lieu of recorded heights and weights. Random reviews of these

patients’ charts for accuracy of stated information will be conducted.

3. Documentation must be present of participation in medically supervised weight loss

program. For purposes of coverage, we (BCBS) recognize medical supervision of the

diet and activity program by practicing MD's who are not bariatric surgeons, such as

family practitioners, internists, and other primary care specialties. Documentation

provided by these health care providers will be recognized in the review process. At

least one attempt must occur during the one year prior to request for surgery or date

of surgery. Documentation must support participation in the program for six

consecutive months. The following criteria must be met for this participation:

▪ Documentation of participation in a physician supervised program of nutrition

and increased physical activity (including dietitian consultation, low calorie

diet, increased physical activity and behavioral modification). Documentation

of program participation must appear in the medical record by the attending

physician. Documentation should include comments by the physician

regarding patient progress or lack of progress. A letter does not meet this

requirement. There must be medical records to document medically

supervised weight loss attempts;

OR

? Acceptable with medical record documentation of medical supervision are:

Weight Watchers, LA Weight Loss, Jenny Craig, EatRight etc. Not

acceptable are self-directed programs such as joining a gym, Atkins’ diet,

calorie counting, low fat, cutting back, internet programs, etc.

4. A complete history and physical must be performed by the bariatric surgeon to

include height and weight.

5. The patient must be at least 18 years of age.

6. Due to the surgical morbidity associated with concomitant pulmonary disease

coverage will not be provided for anyone who has smoked in less than eight

weeks prior to surgery.

[awomangodcanuse 0]

sounthern missy have u been going to ur doctor for long? do u have a relationship with him/her. my doctors knows all the stuff i have done to lose weight and has sign the papers for me already! if your doctor supports the surgery they will make it happen! weight watcher can also be used you have it in doct. just go back to weight watchers and have them fill out the paper work !

P=pray

U=until

S=something

H=happens!!!!!!!!11

[Southern Missy 1]

Thanks wrestler and awoman....

I typed up a letter for my doctor yesterday and included my WW booklet with it. It was faxed to him this morning. Now I am just praying that he will sign it.

AWOMAN, yes, he has known me for multiple years and knows my struggles. I guess right now I am just with the mentality of what could go wrong, probably will. I sure could use some prayers right now.

WRESTLER, thank you SO much for the info. It was VERY helpful.

[Savedbygrace 11]

Any word Missy? I have BCBS of AL and using Dr. Miles too!

[Southern Missy 1]

Nothing yet, Wendy

Just waiting.. waiting.. waiting..

(insert Jeopardy theme music here) :shades_smile:

[ebonie1015 0]

Hi Southern Missy-

I just joined this site yesterday and noticed your question. I may be of some help with this. Hopefully, everything has already gone smoothly and you are on your way to approval:smile2:.

When I first started my journey to have WLS, I had (and still do) BCBS of AL. When I found out that we could use WW as our six-month diet, I was overjoyed because I had been doing WW for 7 months prior to me starting the process. My PCP knew I was attending WW but he is an old school doctor who doesn't document everything but I had ALL of my WW documentation (booklet, cancelled checks, etc). I submitted all of this information to BCBS and they denied me because my PCP did not see me three times during the six months that I was on WW and it was not documented in my chart. You must have three documented physician visits indicating you are on WW, what exercise you are doing, weight loss/gain. It has to be in your chart. So even with all of my proof of WW, they denied me. They are very strict about that.

I even had my doctor go back and add notes to my chart but they still wouldn't cover it because I didn't see him three times in that six months. I was bummed but it was ok. Now I know exactly what they want so they will have no room to deny me this time for missing information. I have all kinds of stuff documented in my chart now so when I do submit, hopefully, everything will go smoothly.:sad:

I hope this helps some with your questions about BCBS of AL. Keep me posted on how everything goes.:scared2:

Ebonie