Question:
Has anyone been aproved with BCBS POS without having to do the 6mt supervised diet?
— LisaMarie (posted on August 11, 2005)
August 11, 2005
There are some rare instances that they will forego it, but I have a few
questions for you. Why do you feel that you should get around it? Don't you
think that you could benefit from it? Did you find out all that BCBS POS,
your policy requires and have you been doing it for 6 months? There are
many reasons that the insurance requires a 6 or sometimes a 12 month
supervised diet try, mainly to make sure that this has been your last ditch
effort to try and loose weight. They also need to find out if you are going
to be disciplined to live out the WLS lifestyle, which in many instances
the 6 month diet try is all about. You need to learn new eating and
lifestyle habits which you will with the 6 month try. Some insurance
companies will require you to see an exercise therapist, psych doctor
during that time, monthly weigh ins with your PCP and monthly meetings with
a dietician (sometimes not all). I had an eight week practice diet with my
surgeon's office and I learned so much, it only scratched the surface of
what I needed to know when I was PO. I know that you are probably thinking
that if I could diet then I would not need WLS, well, the 6 month
supervised diet is not completely about that it is much more. Good luck on
your journey. When you do find out exactly what your insurance requires,
make sure that you get it in writing and exactly who you spoke with and
date and time if in the event that you need to appeal later on down the
road.
— ChristineB
August 11, 2005
Hi Lisamarie, I have BCBS POS and did not need to do any additional dieting
supervised. I have been dieting most of my life. When I filled out the
questions and dieting is one of them, I guess they were satisfied with what
I had already done. On a positive note, I was approved in 48 hrs after the
paper work was submitted. Good luck with your journey.
— WilsonCrimson
August 11, 2005
BCBS now requires the 6 month diet...A friend of mine had her surgery in
the begining of June and they told her that as of July 1 it was a mandatory
requirement.
— dreamy6501
August 11, 2005
Hi again. I am in no way trying to get out of anything. I have been
dieting for years now, trying everything under the sun. I am a registered
nurse and i actually teach others what they should and shouldnt be eating.
I just need help sticking to it myself. I just want to get a start on it
if i need it medically supervised. I have had babies very recently, 2002
and 2003 they are 11 mths apart. So the dieting that i have been doing has
not been written down on a dr. s progress notes but it has been done. The
insurance companies should not dictate this to us our doctors should decide
but of couse they cant do that anymore because of all the red tape. But if
this is what i need to do then i will do it. I will find out shortly from
the insurance company but i was just wondering what others had to say about
it. Thanks for the info and have a great day!
— LisaMarie
August 11, 2005
Hi -I have BCBS PPO and my request was submitted around the second week of
July and approved less then three weeks after. I never had anyone ask or
mention the 6 mo diet supervised or non. Each policy is different - yet I
would ask questions or look over your Policy. Good Luck!!
— Jan D.
August 12, 2005
It varies by plan and by state.
<p>I love how everyone (doctors and some members of this board alike)
assumes that if we do a 6-month supervised diet it will automatically
ensure we are successful and will change all our bad habits and keep all
our weight lost, off forever. Let me tell you in my case it ain't so. And
I sincerely doubt I am the only one in this situation.
<p>I've lost 200 lbs at one time, through the old food pyramid of
dieting and exercise. Trust me in 13 months I had developed wonderful
eating habits. But the exercise became obsessive and was not something I
could do the rest of my life. Add in severe depression arising and poof, 8
years later I had gained it all back.
<p>Next I did WLS and lost 252 lbs in about 14 months. At 30 months
PO I am struggling with crappy eating habits and a 20 lb weight gain.
Fortunately the depression is under wonderful control and not a factor this
time around. The bottom line is the surgery will force a person to lose
the weight as long as they do not intentionally try to sabotage the surgery
in the 1st year. Your tiny pouch (RNY) or short common channel (DS) will
see to it. How can one not lose weight on 2-4 ounces of food? I am
assuming that a person was given a proper surgery for their situation and
that it was done right. I had wonderful eating habits until my 1st PS at
12-3/4 months. Something went wacko after that and my eating changed
drastically and I found candy again, and I do not mean just an occassional
piece. I mean every day. I am confident I will never see 442 lbs again
and know that the tool is definitely there and does limit how much I can
eat. But even though I know all the right things to do and changed my
eating and exercise habits, it is very possible for the old habits to sneak
in. My feeling is get the people into surgery right away and require
mandatory counseling with an eating specialist and mandatory attendance at
support groups for the first year and have the insurance company cover
those costs, so that money cannot be an excuse. These two things are going
to do a lot more to ensure someone is successful long term, much more than
a 6 or 12 months supervised diet in my opinion. People who are sick and
cannot move due to their size are not helped by waiting. In many cases
their risk of dying on the table is just increased the longer surgery is
put off. If a person is borderline in qualifying and clearly hasn't made
enough effort at dieting and seems to be in this for the "looks"
factor, then those people should be required to have the supervised diet so
that they truly understand what they are going to do to their body and that
it isn't a quick fix. Those of us that need/needed the surgery to
literally live, do not need any additional road blocks put in our path. My
surgeon is in full belief of what I just wrote. He has operated on people
in the 700's and would never think of asking them to lose X weight before
he will do surgery. He puts them through the ringer medically and
psychologically to be sure they are a good candidate for surgery and
understand the changes they will need to made, but then it's full steam
ahead. He knows that waiting is not in their best interest.
<p>He did surgery late last year on a man that no one else would
touch because of a serious heart condition. He needs a heart transplant,
but there was no way to get one at his size. The surgeon spelled out the
risks and that he was extremely high risk of dying on the table, but this
man had literally no options left. He was well into the high 400's to low
500's. They did surgery, he has lost a bunch of weight and getting closer
to qualifying for that heart transplant. Waiting might have killed him.
<p>In my opinion a 6 or 12 month supervised diet has zero to do with
the long term success after WLS. It has to do wtih the individual person
and their committment to their new life. Even though I struggle with old
habits I am still 232 lbs lighter than I was before WLS. No matter how one
looks at it that is successful. Nothing to be ashamed about in the 20 lb
regain. While I need to do my job and keep it at that, I know that WLS was
indeed the right and only answer for me. I wish insurance companies would
stop trying to play God and let the people who truly need the surgery on
the table and on with their new lives. JMO Chris D.
— zoedogcbr
August 12, 2005
I was approved and had surgery last February. I do not know if they have
changed their policies since then. I did have a history of dieting using
Weight Watcher, Nutrisystems etc. and I had gone to my gp several years ago
and was given phen fen on which I lost 60 pounds. Of course, we can all
lose can't we? Losing weight was never the problem it was staying on the
wagon afterward. I gained it all back and more. Your existing diet
background may count.
— Beatrice C.
August 13, 2005
Hi LisaMarie -
I have BCBS of California (Sante Group Physicians) and had to complete a
6-month nutrition course. With my plan, the reason I had to do the program,
was the Santa Group. They are the group that required the 6-month program,
not BCBS. I first saw the nutritionist in Jan. of this year, and I'm still
waiting for approval. I've jumped through every hoop they want and still
waiting. If it's any consulation, the six months went very fast. Good luck!
— goddesschyyld
August 13, 2005
i had alist of diets that I gave to Barix, they did all the paper work for
the ins so I don't know exactly what was submitted. I did not have to do
anything else, when I asked them they said the criteria was to be 100%
above my ideal body weight. I was approved with in a few days of them
recieveing the info from Barix.
— **willow**
August 13, 2005
Well, I had the surgery and had BCBS POS. That is just part of there
requirements to be approved. I had the 6 month diet history prior to
needing surgery. If your doctor has ever put you on a diet, record that and
any other diets you've tried, that will be enough. But it is just BCBS,
nothing else. But BCBS POS did pay 100% of my surgery, so I wont complain.
Good luck, its a long road, but its worth it. I started my journey in
September of 2004 and had surgery June 8, 2005. It is a long wait and you
have got to jump through hoops. But it is all worth it. I am down 77 pounds
in 2 months. Well see ya on the losing side soon!
— Kevin R.
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