For the people 6 month required weight loss for BCBS... I have questions for you

josiemorehouse
on 10/24/13 11:32 pm - Villa Rica, GA

So I'm reading up on the BCBS requirements for the surgery, and it says 6 month physician-led weight loss has to be documented.  It must be a MD, and not the bariatrician.  Did you go through your PCP, or did you go through a different physician-led weight loss clinic?  Did you do the WW/Jenny Craig thing where you did 3 visits in the 6 months? 

 

I want to start this right away as I'm ready and rearing to go.  I know my specific insurance plan through BCBS of Alabama PPO does cover it at 75%, and I went to the conference hosted by the surgeon, so I just want to know where to go from here.  The bariatric surgeon's office will call today to set up an appointment, so I'm definitely going to do that, but I didn't know what other people's experiences were with BCBS and the 6-month diet requirement.  I know insurance doesn't cover the 6-month supervised diet, so I'm okay with that. 

 

I'd like to know some individual experiences.  I have a BMI between 39-41 (it changes week to week regardless of what I eat), hypertension, high cholesterol, hypothyroidism, and anemia, so I know I qualify.  I would like to know some similar experiences with BCBS and their 6 month diet.

 

Thanks!

BelieveInFaith
on 10/26/13 11:07 am, edited 10/26/13 11:08 am - NJ
RNY on 08/08/13

Your six month requirement must be with an MD.  My pcp did not do this but my surgeon did so that worked out.  Also you can find physicians who do weight loss programs and stick with that for 6 months.  My bc/bs is with PA.  The insurance will go by your first weigh in with the doctor. So just be aware what the insurance requires your bmi to be at to qualify. 

Never accept NO for an answer.

 

        
4Reel
on 8/16/14 11:50 pm

I have BCBS PPO and am in my second month of MD visits.

I know this is an older post but I was wondering if you were approved or if you are still in the process. 

I have a very similar case because I have been between 39-41 for over 3 years.  I only have 1 co-morbidity (HTN), but did not start taking meds until last year. My surgeon said that I have to provided documentation that it was present in the last 3 years.  I also have PCOS and have taken Metformin for a few years.  Hopefully this will get me approved... Fingers crossed.

      

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HW 240    SW 227   GW 130  M1-

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