Newbie with some Questions

[stacy0830 0]

Hi everyone! I'm just starting my process. I received my referral from my PCP and have an appointment for the seminar and a "bod pod" test on March 2nd. I did call me insurance who gave me their requirements. I see that alot of you had to see several specialists. Is that a requirement of the surgeon? I have BCBS of IL and it states I need a psych eval, but not cardio, etc.

Also, this is a part of requirements for surgery thru insurance:

Documentation of active participation in a comprehensive, non-surgical program of weight reduction for at least six (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 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 and 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. Ongoing support for lifestyle changes to make and maintain appropriate choices that will reduce health risk factors and improve overall health.
   

I have been seeing my PCP every month since OCtober and my weight has always been discussed and she gave me her advice on how to lose weight, etc. Will that qualify as the first 5 months in 6 month participation or is more required?

[plain 12]

Hi everyone! I'm just starting my process. I received my referral from my PCP and have an appointment for the seminar and a "bod pod" test on March 2nd. I did call me insurance who gave me their requirements. I see that alot of you had to see several specialists. Is that a requirement of the surgeon? I have BCBS of IL and it states I need a psych eval, but not cardio, etc.

Also, this is a part of requirements for surgery thru insurance:

Documentation of active participation in a comprehensive, non-surgical program of weight reduction for at least six (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 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 and 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. Ongoing support for lifestyle changes to make and maintain appropriate choices that will reduce health risk factors and improve overall health.
   

I have been seeing my PCP every month since OCtober and my weight has always been discussed and she gave me her advice on how to lose weight, etc. Will that qualify as the first 5 months in 6 month participation or is more required?

Hi Stacy....I'd think that if your doc documented your monthly weight. then that would satisfy all of the above. However, I'm not an insurance expert, and I secretly think all insurances look to deny everything if they can, lol. Good luck!!