BCBS 6-month diet question

[Northern Mist 2]

I too am begining my lab band journey. I see the surgeon on April 9. I have BCBS of IL and have a question concerning the diet and the six month span. When I phoned the insurance company I was told if I had been on a physician supervised diet within the last two years then that would be all I needed. Do you know if this is true?

Don't trust them!!

I too was told, in very general terms, that I "only" needed to be on a 6 month diet - talk to my nurse or doctor each month with weight taken and fulfill the other requirements (5 year history, pysch eval., nutritionist appt. etc..) and I would be all set with getting the surgery approved. WRONG!! I submitted everything, including a 6 month diet w/doctor, all tests required by insurance and surgeon, even a diet/excersize log for 10 months - they denied me saying my doctor wasn't specific enough in her notes about the diet program I was on and they needed more than weight and blood pressure for five years - they needed a doctors notation stating I was obese for five years!?! The weights and rising blood pressure stated at every physical, every year wasn't good enough??? The 10 month supervised diet wasn't explained fully enough??? My doctor was MAD - she called and wrote a letter stating everything again but it didn't matter.

I thought I was dotting my I's and crossing my T's. If I can tell you anything at all - Get specifics from the insurance company, show your doctor and have them be very specific and long winded about your diet and excersize plan.

No, I will not give up. I've paid my dues with BCBS IL for 14 years and have never used the insurance beyond the basic check-ups, allergy issues and colds. I have apealed and I will win eventually!

[mandilou 1]

Misty-

It's so funny (well, not really) that you posted that, because I just had a lengthy talk with a rep at BCBS-IL re: the whole 6-month diet, etc. She said that the review board will look for MORE than one visit a month with your doctor/nutritionist/dietician, and will expect LOTS of detail. She did mention that they WILL expect at LEAST a five year history of obesity, and said they really really focus on "medical transcripts" - i.e., the actual photocopies of your charts. She said that some doctors write letters or whatever else, and that isn't good enough.

I told the surgery center where I'm getting banded about this. She said she was glad I let her know that, because they might have to alter their 6-month plan for BCBS-IL patients. I guess another patient with the same insurance has been getting the run around quite a bit from them. :frown:

Ultimately, she said BCBS-IL was the most difficult carrier they've dealt with yet. :tt1:

[Northern Mist 2]

I hope you have better luck than I did. I was told (after my denial) that only one visit a month was required (per my policy) but my doctors notes were not lengthy enough - apparantly short and to the point is NOT what they're looking for. My doctor has now become verrrrry long winded in her notes at every visit!

I've seen people with BCBS Il. fly through the first time and some fail over and over. We shall see......

[catseye 0]

I was very worried about the doctor's notes for these visits because I didn't want to have to do it over again if I already had to wait six months for approval. I decided to go to a nutrition center that the surgeon's office works with on a regular basis because they would know what insurance companies expected in terms of notes for surgery approval.

Each of my monthly visits is with three specialists and lasts about two hours (a nurse practitioner to oversee it, a psychologist, and a nutritionist). I've also got food and exercise logs that I go over with each one of them (we talk about different things in each case).

I got 7 years of weight and blood pressure history from my gyne's office last week (copies of the notes) which should cover that requirement. I don't really have any comorbidities (my blood pressure has gone back down to normal since regular diet and exercise) so my primary care doctor is just writing a letter of support. I really only see him when I'm 'sick' anyway.

I should be submitting to BCBSIL in about two weeks (my psych eval is on the 22nd).

I've got my fingers tightly crossed that it will all go well.

[Brandy~ 2]

I was so worried about this too when I started my 6 month diet. I assumed I would do all this and never get approved or that they would drag their feet. Exact opposite. Alot of people are so quick to complain that their insurance won't pay and drags them through the mud but mine didn't! Hooray.

I started in Oct 07 and made sure not to miss 1 appt. While I was going to the 6 appts I did all the other requirements that my insurance and surgeons office required. So that I felt like I was getting somewhere I would schedule each of the extra appts a month or so apart. I went to my last appt with my dietitian on 4/2. My doctors office submitted to the insurance and a day and 1/2 later I got a call from them saying I was approved and my pre op appt is on 4/17... NEXT WEEK!

[eat-right 0]

Taylor hello You said that you had already had your six month diet completed before starting the whole process. With Cigna insurance do you think as I have been going to a Diet specialist for a year and 1/2 every three months not monthly he did everything that is on the sheets the surgeon's office gave me temperature blood pressure weight? and it was documented over this time I had gained and lost at this time BMI is 37 I have been treated for hypertension arthritis & steroid injections in my back and joints for pain I have been working so hard on losing this wt thanks for all your help

[blondie2 0]

I too have BCBS of IL. Two weeks ago I completed my 6t month Dr. Supervised weight loss visits. I started looking into this process May of '08. At the end of May I had my 1st psych eval, 2nd eval was later that week, and my third eval was in the begining of June. Mid June I had Nutritionist appt, and Bariatric Dr. Appt. The only thing that was left was my 6 month. I started my 6 month in Aug. Because the Dr. office thought I could get approved based on all of my records- They submitted all my info, It was denied based on the lack of 6 month diet with a dr. So, my info was sent to obesity law by my dr.'s office.

They have been great! They resubmitted my information last week and I am anxiously awaitng to hear from BCBS! I think that your surgery is usually scheduled within 3-4 weeks of approval.

[adagray 1]

I don't have experience w/BCBS, but I would recommend selecting a bariatric surgeon and start working w/their office sooner rather than later on getting your preapproval. I went to a seminar w/the bariatric surgeon that my PCP recommended, submitted all my info to them. They just called me back today to go over it and to let me know I needed the 6 month diet (which I already knew I needed). I set up appointments to see their nutritionist to complete that rqmt. She asked for dates in March for mtg w/the surgeon and I asked if I could meet w/the surgeon earlier and she said no problem. This first mtg w/my bariatric surgeon also includes the EKG, psych eval, etc. all in the same visit. I also want to talk to them about getting a sleep study done since I suspect I may have sleep apnea as well. In any case, I figure I'd rather meet w/the surgeon earlier rather than later. That way if there are any additional rqmts, I have more time to work those out during the same time I am doing the 6 month diet. Also, on some insurances (as w/Aetna - which is what I have), I understand that if you have everything else done, you can submit for preapproval before the 6 month diet is completed and get an approval pending the completing of the 6 month diet (which basically says you are approved as long as you finish the 6 month diet). That is what I want to do so that I am good to go once the 6 month diet is over. :->

[Ruby3901 0]

Hello to everyone. I wanted to update my last message to let everyone know what has been going on with my weight loss program. I completed the six month diet program, did all the testing (nine months worth) and had the doctors office submit for my surgery. My doctor had wanted to do a RNY and I wouldnt consider it since my mom had it done several years ago and had to be flown to Nashville for an emergency re hook up. Her friend that had worked with her passed away due to complications with the RNY. My doctor said he would not consider a lap band because I have a BMI in the fortys. He did however tell me he woud do the gastric sleeve. I said yes to the sleeve and had contacted the doctors office many times with information from the message boards as to billing codes etc thinking I was hekping. They always would tell me that they had submitted many of these and would probably be rejected the first time but they would get the approval through using an appeal. Well after all the testing and six months of a diet plan they submitted I was denied and then they appealed and the insurance company said they wouldnt approve anything but the RNY. So after all this I'm right back where I started. I will not consider the RNY so the doctor and I have parted ways. All of this was a waste for me. My out of pocket for the co-pays was somewhere between $3700.00 and $4200.00 I have nothing but bad feelings about the whole mess.

[daco525 0]

After I went to my seminar, I wanted to start the process immediately. I called and had my psych and nutritional eval done and one appt of the 6 month before I even met with the surgeon for consultation. He was impressed with how much I had already started. He said all I need to do is finish the last 5 month weight loss visits, which ends May 1st and then he anticipates BCBS approval in two weeks and he thinks I should be banded memorial weekend. I hope it all goes this smoothly. I have a BMI 38 but several co-morbidities. Good luck to all.