insurance approval/medical necessity

[nylahkay21 0]

Does anyone have BCBS insurance that is required to prove medical necessity for the surgery by first trying a 6 month medically monitored weight loss?

My insurance is requiring me to have my doctor submit paperwork documenting the work we have done over the last 6 months for me to try to lose weight in other ways.

I am nervous that for some reason the insurance company will reject the work we have done even though through continued monitoring and thousands of dollars worth of tests, we have determined that all of my health issues are of course tied directly to my weight.

I meet with my doctor next week to talk to her about submitting the paperwork to insurance for approval. Is there anything I should tell her to help insure cooperation on behalf of the insurance company?

[Thinner*me 0]

Hi:

I understand your frustration, but not to worry. It is just a formality. I have BCBS and here is what I did to get approved. I had my private doctor write me a letter stating that I was obese and needed to lose more than 50 lbs. The letter also stated that I have joint pain, sleep apnea, depression, high cholesterol for over a year, and all of these problems are related to my weight. She also stated that I have tried unsuccessfully to lose weight for over 20 years (which is true) and that she has been counseling me about nutrition and weight loss for over a year (which is also true). Finally, she wrote that she supports my decision to have this procedure. The letter MUST state that you have no cardiac or respiratory problems that would put you at risk for this surgery.

I also had a chest X-ray, echocardiogram, nutritional and psych eval (required by BCBS). I submitted all this to the surgeon, who then turned it in to BCBC, and they approved me in 5 days. BCBC does not require any weight loss befor the surgery. Only a BMI of 40 or 35 with a secondary illness such as Diabetes. My surgery is scheduled for 11/20/09. Hope this helps;0)