6 Month supervised diet (insurance)

1stlady
on 11/30/17 6:34 am - VA

Hello,

I have Anthem BCBS just wondering if anyone else out there has to do a supervised diet to have insurance approval. I am actually revising from the lap band to the sleeve due to it simply not working for me anymore.

Ms_Olivere
on 11/30/17 8:08 am

Yes for my revision with FED BCBS I had to do the supervised diet/nutrition counseling and be cleared by a mental health eval.

HW:214.9 10/13/17 Revision Lap Band to Sleeve 11/8/17 SW:205.5 CW:187.6

Goal Weight: 145

Pre-op: -9.4 M1: -11.5 M2:-4.4

Virgie Tschirhart
on 12/2/17 9:30 pm - Midwest City, OK
RNY on 12/27/17

Hi Ms_Olivere,

I have Fed BCBS also. Do you remember how long it took for them to approve you?

I am trying to get my packet sent to them. I thought I was done with everything. I even had to use a CPAP machine for 14 days before they send it through since I do have sleep apnea. My 14th day was 30 Nov 17 and I asked her is there anything else? She said no I did everything I was supposed to do.

I already did the 90 day supervised/diet/nutrition counseling and have been cleared on my mental health. I have HBP, Type II diabetes and a Hiatal Hernia with GERD. I have a BMI of 36. I called on Dec 1 to see what the status on my patient package if it was sent to insurance. The medical assistant left me a voice message and told me that I have to call her she has some a couple questions for me. By the time I heard her message, they were closed. I really want to get this approved before the end of the year so I won't have to pay a big deductible. Monday, God willing, I will be calling her to see what she needs now......

Virgie Tschirhart

Lap Band - 2008, Sleeve - 2009, RYN - 2017

Started Program Weight July 13, 2017 - 194.2

Before Surgery Weight December 27, 2017 - 185.0

Current Weight - February 2018 - 161.0

Ms_Olivere
on 12/4/17 7:48 am

With your Co-Mobids you should get approved in about 2 weeks. It took me a month I originally was denied but my provider appealed the denial and then I was approved. Good luck to you!

HW:214.9 10/13/17 Revision Lap Band to Sleeve 11/8/17 SW:205.5 CW:187.6

Goal Weight: 145

Pre-op: -9.4 M1: -11.5 M2:-4.4

Virgie Tschirhart
on 12/4/17 9:34 am - Midwest City, OK
RNY on 12/27/17

I sure hope I get approval soon. Thanks so much for replying.

Virgie Tschirhart

Lap Band - 2008, Sleeve - 2009, RYN - 2017

Started Program Weight July 13, 2017 - 194.2

Before Surgery Weight December 27, 2017 - 185.0

Current Weight - February 2018 - 161.0

dcopehp
on 12/14/17 10:22 pm - New York, NY

I have Anthem BCBS in NYC and they also have a 6 month supervised diet revsion as well. i'm just starting mine to go from and RNY to a DS.

JJT
on 12/23/17 5:02 am
Revision on 09/14/17

I had BCBS Anthem which required me to only use Center of Excellense. Make sure you look into that because if they approve you and they require this they won't pay if you don't use them. I had to go through six months and I took advantage to lose weight. They won't deny you for losing some weight. I went through the exact program a first time RNY would go through. When they told me it takes two weeks to get an answer I just rolled my eyes. Two weeks later they called for a surgery date I nearly passed out.

Heather :o)
on 12/26/17 4:26 pm

I have Humana. I have diagnostics showing cause to remove the band but it's not urgent. My BMI is like a 26.5 and I want a revision. There response was six months of dietician counseling, six months of weigh ins with surgeon, a repeat psychological evaluation (it's been 13+ years since my initial) documented weights for the past 5 years, and a TSH level (my most recent was July and normal). I called them up to ask if I could get my psych evaluation by an LMSW or I've been in therapy with a mental health nurse practitioner for 12 years, she has a PHD and is addressed as doctor but it's a doctorate in nursing. They said it didn't look ok specific and actually sent me the policy, the first time I called they wouldn't send me the policy. So I went to the dietician for month two weigh in and she said it's always a psychologist or psychiatrist. So I pulled out the policy and read all 25 pages and there was nowhere in there that had all the steps they are requiring of me for removal and revision ????. All that was for initial surgery, it was only a surgical defect with the band for removal and revision. I sent an email to the person who sent me the policy and ask that they review it again and didiscuss with a medical director to see if it was really necessary (I work for my insurance company but not for commercial, I'm contracted for government and military but I know the language.) I called the surgeons office and spoke with the girl there who said these were the steps and they could put in but if most likely be denied and I'd lose the appeal option. So I'll wait to hear back from the woman I emailed. So this is a total short story long but every insurance company has a policy for everything including everything bariatric, some you can even find on google. Request a copy of it, get to know it so you are prepared for what they want and can question if you are being told something that doesn't match what policy says. For example I was just told weigh ins. The policy for if this was initial surgery was the same six months but it stated without weight gain. Now I'm a little stressed bc I've started doing TRX and am building muscle and losing inches but I'm up about five pounds. So I hope that doesn't effect me. I think I'll see if I can get my trainer to do my measurements so we can submit that if these five lbs don't come off as my body adjusts.

Believe nothing, no matter where you read it, or who said it, no matter if I have said it, unless it agrees with your own reason and your own common sense. - Buddha
×