Wording of requirments

Girl_in_green_dress
on 10/27/16 2:04 am - Louisville, KY
VSG on 10/16/17

Years ago (2011) when i first started the process for bariatric surgery (got talked out of it, long story) the wording of my insurance policy was "doctor supervised diet". 

 

I have a different insurance now, BCBS of TN and the wording is alot different. 

 

  • Attending physician documents adherence to a non-surgical weight loss program (e.g. dietary management, behavior modification, and/or exercise) with ALL of the following:

    • Most recent attempt was within 2 years of request for surgery

    • Participation was for a minimum of 6 months.

 

Can anyone tell me if this is the same thing, or if they just have to say yeah they have done this this this and blah of # months.

 

I tried asking the nice BCBS service rep for clarification, but she said that's all it said. I have my consult in december. But I have had some hiccups with my PCP retiring our of no where, and the area I live in has a doc shortage, so it's been one thing after another. 

 

I had read a few places that some BCBS networks had changed to not needing a "supervised diet" and just wondered if this was the wording for that.

 

Thanks for any help

beccakevinmom
on 12/12/16 11:42 am - wallingford, CT

Hi - curious if you got your answer?  I have my appointment with my surgeon in mid January - my dr knows I have been trying to lose weight and have been up and down since I met her - I would just HATE to have to wait 6 months to prove I cannot lose weight!! 

267/258/223.9 Turkey Day Challenge 15 pounds minus 2.1lbs
Highest/Surgery/Current

Girl_in_green_dress
on 12/12/16 11:59 am - Louisville, KY
VSG on 10/16/17

Nope nothing. someone at the surgeon  office is going to look into it after I see my new pcp and get some paper work turned in to her. ill let you know if anything is clarified!

Doxie-mom
on 12/17/16 7:55 am
RNY on 03/13/17

Hello, I have BCBS of MN and I am jumping thru the hoops for insurance now.  I made my own appt with a bariatric surgeon on Sept 21, at that appointment I spoke with the surgeon's nurse, the surgeon, and I was also introduced to a patient advocate who takes care of everything.  My insurance requires the same thing as yours and this is what I had to do.

I had to have an Appt with a nutritionist and a psych evaluation (both set up by the advocate) both have to approve you for surgery.

I had to make an appointment every month for 6 months with my primary care physician and weigh in and talk about dieting, exercise etc.  Because I had met with my PCP in August and we spoke about diet and exercise and she put it in my chart this counted as my first monthly session.  I have my last session on Jan 5 and after that they ( bariatric nurse or advocate) will send paperwork to insurance and I wait for approval. 

Once I am approved I then have to take some nutrition classes (3) and then they can schedule my surgery.

If you have any questions feel free to ask I will help if I can.

Tammy

HW: (9/28/16) 369.8 / SW: (3/13/17) 285 / CW: 162.8

Pre-op loss (6 1/2 Months) - 84.8 pounds

M1 - 17.2, M2 - 17.2, M3 - 13.4, M4 - 15.4, M5 - 13.8, M6 - 13.6, M7 - 10.8, M8 - 9.6, M9 - 5.0, M10 - 2.4, M11 - 3.8

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