Anyone not have to do 6 months w/BC BS PPO?

[Mrsace13 0]

My drs office is telling me that all B/C B/S PPO is required to do the 6 months and my insurance mailed me all the info and it does not say anywhere in there that I have to do the 6 months so I called them and they yes I did need to do the 6 months and then they started looking at my policy, put me on hold and came back and said it doesn't say it anywhere.

Has anyone had them and not had to do the 6 months? My drs office said they can go ahead and submit it and we could try, all they can do is decline it I would guess then I would just finish out the 6 months. They said I could fight it since it doesn't say it, has anyone ever done that and won?

Thanks. If I have to do the 6 months, ok, I will, however if I don't have to, even better.

[babe134 0]

I have bc/bs ppo but all bc/bs policies differ and certain exclusions can be made by employers yada yada yada. I have not yet been approved it is being submited tomorrow I think But did Not have todo 6 months I am expecting to hear if im approved in 2-3 weeks so will update you.

Edited October 15, 2008 by babe134

[Mrsace13 0]

I have bc/bc ppo but all bc/bs policies differ and certain exclusions can be made by employers yada yada yada. I have not yet been approved it is being submited tomorrow I think But did Not have todo 6 months I am expecting to hear if im approved in 2-3 weeks so will update you.

Are you federal? They said they do not have to do the 6 months. So was it just your policy didn't require it? You have given me hope :biggrin: let me know how it goes

[mamanmidwife 0]

I have empire bc/bs hmo and when i got the policy it had been changed january 2008 (and I got it in april) and DID NOT require the months. But of course call. and iknow for sure that previously there had been the 6 mo supervised diet

[kdlee 0]

I have Anthem BC/BS PPO in Ohio. It is not Federal. I did not have to do the 6 month diet. I went to the seminar March 15th and was banded June 30th. Your doctor's office is wrong. Obviously not all BC/BS subscribers have to do the 6 months. I would have them submit and see what happens. Here is the specific policy from Anthem's website: SURG.00024 Surgery for Clinically Severe Obesity

There is a checklist at the bottom of that link. Those are the only things required. Good luck! :biggrin:

Edited October 15, 2008 by kdlee

[lyndzileigh 0]

My drs office is telling me that all B/C B/S PPO is required to do the 6 months and my insurance mailed me all the info and it does not say anywhere in there that I have to do the 6 months so I called them and they yes I did need to do the 6 months and then they started looking at my policy, put me on hold and came back and said it doesn't say it anywhere.

Has anyone had them and not had to do the 6 months? My drs office said they can go ahead and submit it and we could try, all they can do is decline it I would guess then I would just finish out the 6 months. They said I could fight it since it doesn't say it, has anyone ever done that and won?

Thanks. If I have to do the 6 months, ok, I will, however if I don't have to, even better.

Hi, I have BC/BS PPO of western PA and I am going throgh the six months as we speak. No way around it...at least for me anyway.

[karook54 0]

I have BC/BS of Al PPO and I had to do the six months. I finished last month on the 18th, summited to ins. the 30th and had an approval by 4pm the same day. My surgery is Monday, Oct. 20th. If you do have to do the 6 mo., it goes by much faster than you think. Stay positve and it will over before you know it. Keep us posted.

[MiniBand 0]

My experience is whatever they tell you on the phone, they lie. LOL. I asked the first time and they told me no. I have Horizon BCBS of NJ. First I called and asked if it was covered and what I would have to do. The woman basically said, just get pre-determination. She didn't give me any other details. I said are you sure, and she said yes. Well I found out later that it was not true. Then I was denied anyways but I am appealing that right now.

I have open enrollment right around the corner and I am so tempted to switch to Cigna or United but I don't want to mess myself up.

[Mrsace13 0]

My experience is whatever they tell you on the phone, they lie. LOL. I asked the first time and they told me no. I have Horizon BCBS of NJ. First I called and asked if it was covered and what I would have to do. The woman basically said, just get pre-determination. She didn't give me any other details. I said are you sure, and she said yes. Well I found out later that it was not true. Then I was denied anyways but I am appealing that right now.

I have open enrollment right around the corner and I am so tempted to switch to Cigna or United but I don't want to mess myself up.

You are so right. I called and one lady told me that my insurance covered the surgery only, that is would not cover anything I did for the surgery. I called my drs office and the lady in charge there about had a fit, she said she had never heard of anything like that. So I called back not even 10 min later and spoke to a guy that said that was incorrect information!! I told him he needed to find the lady I had JUST spoke to and correct her then since she had me really upset. You can't trust them and I asked if they keep activity notes when they speak to us so when I call again they should know who spoke to me and what was said to me but he never really answered me.

I have open enrollment and have the choice to go to United as well, however mine at my work does not cover this at all, good thing I called. Plus I was told that with United you have to have a BMI of 40 or more and I'm just right under that but they do not require the 6 months.

Good luck everyone and thank you for your input to my question, this is the hardest part is trying to get approved and waiting for the approval!!

[Mrsace13 0]

I have BC/BS of Al PPO and I had to do the six months. I finished last month on the 18th, summited to ins. the 30th and had an approval by 4pm the same day. My surgery is Monday, Oct. 20th. If you do have to do the 6 mo., it goes by much faster than you think. Stay positve and it will over before you know it. Keep us posted.

I know, if I have to do the 6 months then I will deal with it of course. Look at my join date here, lol, FEB and it took me unitl Sept to finally go to the seminar!! If I would have started in Feb, I would be banned already.

[*slim* 2]

I know you asked if anyone DIDN'T have to do the 6 months diet, but here is what happened with me. I have BCBS PPO, and it is stated that I am to have tried a 6 month diet. BUT they accepted a six month period from less than 2 years ago where I went to the doctor every month for six months. Diet wasn't the reason I went to the doctor, but it was discussed. The doctor's office was glad to fill out the six month diet papers showing my weight and BMI and the diets discussed. If you had a period like that in the last 2 years, they may accept that without you having to start over with a diet. Or if you have had more than one visit in a row now, maybe you could continue those so that you are not starting over. This is a "just in case you have to" measure. I hope that it turns out that you don't have to do one. I think you can send emails to BCBSAL's customer service. If you can, they can send you what is exactly stated in your policy. That way you can print a hard copy or save it. I did that with BCBSIL and saved the information for later. Good luck to you!

[swiley 0]

My drs office is telling me that all B/C B/S PPO is required to do the 6 months and my insurance mailed me all the info and it does not say anywhere in there that I have to do the 6 months so I called them and they yes I did need to do the 6 months and then they started looking at my policy, put me on hold and came back and said it doesn't say it anywhere.

Has anyone had them and not had to do the 6 months? My drs office said they can go ahead and submit it and we could try, all they can do is decline it I would guess then I would just finish out the 6 months. They said I could fight it since it doesn't say it, has anyone ever done that and won?

Thanks. If I have to do the 6 months, ok, I will, however if I don't have to, even better.

I have BC/BS of GA. No 6 month diet required just 3 yrs of trying to diet,

nutritionist, psych evaluation, and a medical form from my family doctors.That was it. sleep eva. was not required but i had to do it anyway.

[vzghj3 0]

Teresa and anyone else going through the approval process...I recommend you request a Health Care Advocate through BCBS to assist you with the approval process. I too was getting the run around, every time i called I would get a different answer. And when I started this process, BCBS at the time was requesting 12mos of supervised dieting within a 2 year window and then of course at 11 months in they reduced it to 6 mos. Oh and between all that my company changed my BCBS from MI to TX, which TX BCBS had different guidlines. Any way the Health Care Advocate was a big help with getting the paper work and approvals pushed along. She coordinated everything between the Dr and BCBS. This is a free service offered by BCBS. Don't wait until you are ready for approval, call on day one. It took me 15 months to get through all the beauracy and could have been shortened if I had contacted a Health Care Advocate in the beginning. Good Luck!

[Mrsace13 0]

Teresa and anyone else going through the approval process...I recommend you request a Health Care Advocate through BCBS to assist you with the approval process. I too was getting the run around, every time i called I would get a different answer. And when I started this process, BCBS at the time was requesting 12mos of supervised dieting within a 2 year window and then of course at 11 months in they reduced it to 6 mos. Oh and between all that my company changed my BCBS from MI to TX, which TX BCBS had different guidlines. Any way the Health Care Advocate was a big help with getting the paper work and approvals pushed along. She coordinated everything between the Dr and BCBS. This is a free service offered by BCBS. Don't wait until you are ready for approval, call on day one. It took me 15 months to get through all the beauracy and could have been shortened if I had contacted a Health Care Advocate in the beginning. Good Luck!

Thank you, this is helpful information. I'm tired of talking to new people there and like others have said, my drs office doesn't really know as well.

Before I started all this I called BCBS and they mailed me the policy, no where does it say anything about 6 months so my drs office is going to submit it and see what happens.

I'm getting worried that the end of the year is coming and of course Jan 1 anything new can happen with my insurance policy and then I will have to go by the new guide lines good or bad, lol.

Thank you everyone, I know I get my best answers right here!!

[jsp 0]

I have BCBS of MA. Before I even picked out a doctor, I checked with my insurance company to see what the requirements were. They even sent me their entire policy on WLS. I didn't have to do 6 months. The staff for the doctor I picked out kept telling me that I had to have 6 months. I sent them the policy and told them exactly what they said. But they were very rude and not helpful at all. I called my insurance company and asked them to put it in writing - that they do not require 6 months. They did it and were very helpful. I went to another doctor and in no time I had my surgery date scheduled.

So my advice is, to have the actual policy sent to you and if they will write a letter stating they don't need 6 months - get it!! And find a new doctor!!