:'( What now???

So sorry this is happening! Doesn't make sense that BCBS is going backwards in this regard.  Best of luck!

I was a referral coordinator for years in another specialty, and I still work in the medical field.

I read the policy change as the 12 months of medical management requirement starts 12/30/16. You have already started your process. How long ago did you have your initial consultation?

Prior to my surgery, I had to explain my policy to my surgeon's referral coordinator. She misunderstood what my requirement s were. I did that by calling my insurance (BCBSAZ at the time), and asking to talk to the utilization management department. I spoke with one of the nurses, clarified my coordinator's misunderstanding, and then called my coordinator. I also emailed the pertinent policy guidelines to my coordinator.

My experience is that some offices are very conservative. Some too do not submit if there is any deviation from the written guidelines. My recommendation is to call the referral coordinator, be calm, polite, and cordial, and bring up the two paragraphs you found regarding changes to coverage, but only after you talk to your insurance.

Insurance companies all use the disclaimer you heard. It doesn't mean they are telling you a pack of lies; it means covered services will be paid if criteria is met and documentation is supplied. 

Customer service often has less access and understanding than utilization management, so they have to reiterate the handbook and policies.

Thank you.  I tried to call BCBS but kept getting transferred and finally disconnected. I will try again Monday and try to get to the department you mentioned.

I got my referral from my PCP 11/11/16.  And had my initial consult 12/9/16.  I also had my first NUT apt in December.  But my EGD, 2nd NUT, and Psych were all this month.  Based on that do you think it was too late to be under the old guidelines?  

Hard to say. In the past year, did you do Weigh****chers, Jenny Craig, or any other type of diet? Maybe MyFitnessPal to track daily? That might count.

The disclaimer in the last paragraph seems to say the 12 month period may be adjusted at the doctor's discretion. That may be something to revisit.

Also, the insurance used your starting weight, so losing weight is okay.

I don't know if this applies to you, but I had/have a lot of issues that contributed to my obesity. I have found therapy helpful. That might be something to pursue as well. Your process may not go faster, but you can still do important work.

How many times did you see your PCP in 2016.  My insurer had the same 12 month supervised diet requirement.  If you did see your PCP in 2016, and he/she is supportive of your WLS, I would recommend drafting a letter for your PCP to sign.  I had been seeing my PCP for other issues, but at each appointment, I was weighed, and we discussed my weight and the fact that I should lose weight.  So I drafted a letter stating that I had been a patient of his for x number of years; my highest weight was x pounds; over the years I attempted to lose weight by (WW, Jenny Craig, OA, his supervision, etc); my current weight was x pounds, a loss of x pounds.  My PCP signed it and I submitted it to my insurer -- it did the trick.  It's worth a shot if you run out of other options. 

Best of luck to you.

Did you submit the letter with your initial request? Or were you denied and sent it as part of an appeal?

Thanks everyone for the information.  I talked to my insurance company today and they said I should be ok using the old guidelines since I had already started the process.  So I am trying not to get my hopes up too high but at least I am not as worried as I was Friday. Thanks as always for all of the support and keep your fingers crossed for me!