Insurance Approval

[gigim 8]

I have BCBS of ILLINOIS, and the requirment is to have 6 months of supervised weight monitoring...Well my Doctor has in his notes for Nov, Dec and Jan. diet notations and nothing for feb, march, But has notes for April and May weight monitoring. Will the insurance co as for 1 more month which will total 6 months???? or will they say that because 2 months were missing that I have to start with April thur August?????Please help, I will be very upset if I have to wait until August...My Daughter is expecting a Baby Boy in August and I wanted to well on my way to healing by than....Thanks Gigi:huh2:

[TexGal 0]

I'm not really sure how yours works, but I have BCBS Texas and was told that if I did not do 6 months in a row then the insurance company would not even look at it. Not really sure how true that is but I believed them anyway. With you it may be different, but no matter what I do wish you good luck.

[mandi813 0]

do you have HMO or PPO???

[catseye 0]

When I asked my surgeon's office and BCBSIL that question, they said the months had to be consecutive and that you had to have appropriate documentation by the doctor.

This is why I went to a nutrition center that specialized in preparing people for surgery -- I didn't want to have to redo any part of the six months.

I'd call if you have a question about it, but it really sucks that your doctor didn't properly document.

- jen

[catseye 0]

Also, just FYI: the policy doesn't state it's just weight monitoring. Here's what they actually want:

Non-surgical treatment of morbid obesity appropriateness criteria:

• Medical record documentation of active participation in a clinically-supervised, non-surgical program of weight reduction for at least 6 months, occurring within the twenty-four (24) months prior to the proposed surgery and preferably unaffiliated with the bariatric surgery program. [NOTE: The initial BMI at the beginning of a weight reduction program will be the “qualifying” BMI used to meet the BMI criteria for the definition of morbid obesity used in this policy.]
  
• A program will be considered appropriate if it includes the following components:
  
  1. Nutritional therapy, which may include medical nutrition therapy such as a very low calorie diet such as MediFast or Optifast OR a recognized commercial diet-based weight loss program such as Weight Watchers, Jenny Craig, etc.
     
  2. Behavior modification or behavioral health interventions.
     
  3. Counseling and instruction on exercise and increased physical activity.
     
  4. Pharmacologic therapy (as appropriate).
     
  5. Ongoing support for lifestyle changes to make and maintain appropriate choices that will reduce health risk factors and improve overall health.
     

[kathystrick 3]

Your surgeon's office should also be able to give you information on this. Let them help you all they can. You are paying them, afterall. They jump through these hoops everyday, so they are a valuable resource. Good luck!