I can use my Curves & Weightwatchers information

tyrind · April 18, 2008

Hello all. I have bcbs of michigan & i called & asked them if i could use my Curves & weightwatchers information for my 6 month supervised diet and they said yes!:cool:But the only thing is my first weigh-in was with Curves in May of 2004. Then i got September through December of 04 weigh-ins with them & January through April of 2005 weigh-ins with Weightwatchers. SOOO do that really matters?? I mean as long as it is 6 consecutive months like they require. I might call tommorrow & ask but i have called with so many questions, they probally know me by now:rolleyes2: I just want to get everything together so when i finish my last 2 appointments, all i want to do is wait for approval & surgery date!. Also do they go by your weigh-in from your first initial appointment? The reason im asking is, at my first initial appointment i weighed 247 which put my bmi at 41. Now i have lost right at 5 pounds which puts my bmi at 39. SOO should i slow up a little:eek: Someone please give me some suggestions:confused: This all so frustrating & at times i feel like just giving up. But then through it all, i know the good Lord will help me through it:wink2:

Mom2_4 · April 18, 2008

I don't know what they use, I would guess it would be the most current weight. This sounds terrible, but maybe load up on the fluids just before going in to get weighed so your BMI doesn't fall below the requirements.

karook54 · April 18, 2008

Hello all. I have bcbs of michigan & i called & asked them if i could use my Curves & weightwatchers information for my 6 month supervised diet and they said yes!:cool:But the only thing is my first weigh-in was with Curves in May of 2004. Then i got September through December of 04 weigh-ins with them & January through April of 2005 weigh-ins with Weightwatchers. SOOO do that really matters?? I mean as long as it is 6 consecutive months like they require. I might call tommorrow & ask but i have called with so many questions, they probally know me by now:rolleyes2: I just want to get everything together so when i finish my last 2 appointments, all i want to do is wait for approval & surgery date!:thumbup:. Also do they go by your weigh-in from your first initial appointment? The reason im asking is, at my first initial appointment i weighed 247 which put my bmi at 41. Now i have lost right at 5 pounds which puts my bmi at 39. SOO should i slow up a little:eek: Someone please give me some suggestions:confused: This all so frustrating & at times i feel like just giving up. But then through it all, i know the good Lord will help me through it:wink2:

I too hope to use my Weight Watchers and Curves. The biggest thing with mine is my W.W. was 05-06 and Curves in 06. One person at my ins. co. said that should work and another told me it wouldn't because it had to be 6mo. of the prev. year. My PCP told me yes it should be used because it was an attempt in the last three years so I really don't know at this point.

karook54 · April 18, 2008

I too hope to use my Weight Watchers and Curves. The biggest thing with mine is my W.W. was 05-06 and Curves in 06. One person at my ins. co. said that should work and another told me it wouldn't because it had to be 6mo. of the prev. year. My PCP told me yes it should be used because it was an attempt in the last three years so I really don't know at this point.

Well I went to my first surgeon's appt. today and BC/BS requires the 6 mo. to be in the last 12 mo. ( which sucks!) So I'm having to start my diet this mo. and it will probably be Dec. before I have my surgery. I thought I would be more disapointed than I am, but I just look at it as one day at a time and the weight I will lose during my 6 mo. diet will be less I have to lose after my surgery. Hang in there and know you're not alone in the struggle. There are plenty of us just like you.

tyrind · April 19, 2008

Well I went to my first surgeon's appt. today and BC/BS requires the 6 mo. to be in the last 12 mo. ( which sucks!) So I'm having to start my diet this mo. and it will probably be Dec. before I have my surgery. I thought I would be more disapointed than I am, but I just look at it as one day at a time and the weight I will lose during my 6 mo. diet will be less I have to lose after my surgery. Hang in there and know you're not alone in the struggle. There are plenty of us just like you. :cry_smile:

Well yes that really does sucks!!!! Im still going to call my insurance company on monday just to make sure cause they sent me the requirements & it just said; these exact same words, The patient has been clinicall evaluated by an M.D. or D.O. who has documented failed medical management including a structured, professionally or physician-supervised weight-loss program for a minimum of six consecutive months prior to the recommendation for bariatric surgery. Saying nothing about with-in the previous year. Is you with BC/BS of Michigian? I know some BC/BS are different than others. Well when i call Monday i will let you know what they said. Thanks so much for your replies!

karook54 · April 19, 2008

Well yes that really does sucks!!!! Im still going to call my insurance company on monday just to make sure cause they sent me the requirements & it just said; these exact same words, The patient has been clinicall evaluated by an M.D. or D.O. who has documented failed medical management including a structured, professionally or physician-supervised weight-loss program for a minimum of six consecutive months prior to the recommendation for bariatric surgery. Saying nothing about with-in the previous year. Is you with BC/BS of Michigian? I know some BC/BS are different than others. Well when i call Monday i will let you know what they said. Thanks so much for your replies!

I have BC/BS of Al and mine doesn't say the prev. year either. It says 6 consecutive months in a one year period prior to predetermination. I thought surely my prev. attempts would work but my surgeon told me yesterday that they would want something within the last 12 mo. But you are right that all BC/BS policies are different. I hope yours will except your prev. attempts. Keep us posted. :biggrin:

Chris61 · April 19, 2008

I would suggest you have them write or you write the letter and have them send in your weights to your PCP Doctor and explain how often you came and what you did there etc. Then have you PCP doctor write a letter to the lapband doctor explain your complete medical history and all the diet plans you have done. I can forward you a letter that I had used to get approved by UHC. Now keep in mind everyone insurance is differant so this may or maynot help.

Chris

tyrind · April 21, 2008

Yes, please forward me the letter you wrote. Any information is helpful. Thanks

HlthySoon · April 21, 2008

I've done insurance and billing and coding for 8 years. I too had six months of medically supervised diet. I had been going to a weight loss support group called T.O.P.S. and a personal trainer at Club Fitness. I had been doing it for years. Insurance varies per employer even if two people have BCBS Arkansas they can have two completely different sets of requirements.

My plan with Cigna wouldnt accept that. I had to start in October seing a doctor every month. After that they would approve it. I did not loose weight during the 6 months I stayed the same for 4 and then gained 2 of the 6. I hated the fact that I was being forced to endure 6 more months. But hey I got through it and I'm being banded next month.

Hope this helps sorry if it wasnt what you were looking for. Best of luck getting the insurance to approve it. If you can prove that there is a dietician on staff or maybe some other registered clinician than just maybe. Good Luck. Take it from me 6 months starting over is rough but you'll get throught it!

tyrind · April 21, 2008

HI. well bc/bs of mich. said that i could use my curves & weight watchers information but now wondering ig it has to be from the previous year. cause the information i have is year 2004-2005 but i have other failed attempted weight loss from year 2006-2007 information my pcp doctor wrote down but just not in 6 month period or not being weighed in for 6 months. but at curves & weightwatchers i was being weighed in. please give what information you know about that if you would. thanks so much

tyrind · April 21, 2008

will you please respond to my last post. thanks

HlthySoon · April 22, 2008

They will want info from the past six months. I too had attempts in the past and they did not accept that. Sorry for the late post. Best of luck to you but I imagine your going to need to start from this current point and even if you dont I would make a doctors appt and start the ball rolling for that process just in case! Best of luck!

tyrind · April 24, 2008

They will want info from the past six months. I too had attempts in the past and they did not accept that. Sorry for the late post. Best of luck to you but I imagine your going to need to start from this current point and even if you dont I would make a doctors appt and start the ball rolling for that process just in case! Best of luck!

Helo. I called the insurance company on Tuesday & asked them how far do they go back with the 6 month supervised diet and they said 4 years!! So by me having my weightwatchers & curves information for year 2004-2005 i should be fine!! YIPPEEE!!!