Question:
BC/BS of IL- Only completed 4 months supervised weight-loss program
I had completed 4 months of a supervised weight-loss program about 18 months ago. Since the insurance company is wanting 6 months, will I only have to complete 2 more months, or will I have to start over? — Suzanne C. (posted on February 13, 2009)
February 13, 2009
You will need to start over. It has to be 6 consecutive months in a row.
Be sure that you discuss with your Dr. your daily diet, exercise and
behavior modification and changes that are being made in each area for each
visit-Ex: Your exercise should be increasing each month even its only by 10
minutes more. GOOD LUCK!!
— [Deactivated Member]
February 13, 2009
Hi...I too have BCBS. My policy stated that I needed to have 6
consecutive months of a Doctor supervised weight loss program. At first I
just wanted to get the surgery and move on, but now I am grateful that they
made me wait. I was able to research more, learn as much about the band
as possible, and prepare myself for my new life. I also challenged myself
to loose 20lbs before surgery. The only prerequisite BC has was not to
gain any more than 5lbs. I was worried if I dropped weight they would
drop me. My BMI was just 35. Please understand I remember the feeling of
frustration...knowing I had to go on ANOTHER diet. I went to the initial
seminar in July and was approved Jan 5th. We submitted Jan 2nd to BC.
Give yourself this 6 months, practice chewing, chewing, chewing. Good Luck
and God Bless. Kimberly
— kfgates
February 13, 2009
Depends on your insurance. Most are 6 months continually without missing
a month within the last 2 years. I was sent by Dr.to dietitian and she
required me to list 3 days of foods, drink, nd just what exercise I did
like walking. Dr was every month continually also just for weigh in and
etc., other things while I was there. Some Insurances are very sticky
However, it also weeds out those who really think this is quick fix or not
mentally ready for this or gives one time to really think about what a life
time commitment this is. It is as much work now as it will be after. YOU
have to do your part in working at exercise n changing your way of eating
for your own good the rest of your life. Going to a psychiatrics for
evaluation and testing also.
Choosing the right doctor is as important. I went to Bridges Center. com.
They make you very aware of what you must do and must attend seminars and
they have their way of helping you understand a healthy way of eating.
They map it all out give you much material. Tell you exactly what to eat
during the first 6 weeks and afterwards, than up to you to either want this
way of living. They tell your WHY you should eat this or that and Tell
you what will happen to you if you don't. This is Tool that will help you
reach your goal but YOU must follow the rules. I see so often some ask
questions on this site, that even before surgery these questions are
asked and answered either at the seminars or one can call and ask at the
Bridges center. But I guess each Dr. or place has their own way of doing
things ...I am glad I made the right choice as to whom I chose to have
surgery with. Good luck and hope this information has helped.
— Eneleh
February 13, 2009
I have BCBSIL however, I found out that even though my insurance is with
them through my company, that my company has a set of requirements that
they have to follow instead of theirs. My companies requirements to have
the surgery were alot less strict than BCBSIL so it was alot easier and
faster to get approved (1 week). I had to have a BMI 35 or over for more
than a year, be over 18, show I had talked to a surgeon, psycholigist, and
nutritionist and knew about all the risks and expectations of life changes,
and had to have 2 of the following: high blood pressure, high cholesterol,
heart problems/sleep apnea, type 2 diabetes, or immobility due to joint
pain. I had everything but the diabetes and immobility. They rejected it
the first time (took 1 day) but they used their criteria not my companies
but once I pointed that out to them they re-submitted it and it only took
another couple of days to get the approval. So you may want to check and
see if your company has a set of requirements they need to go by they may
be easier. I had no idea until I was talking to someone in one of our
other plants in N.C. and she told me. Its worth a look! Hope this helps.
Keep on trying and never give up! It will all work out for you. Keep me
posted!
Hugs...Donna
— gonnabethinfinally
February 13, 2009
I too have BCBS/IL, a PPO plan. There are many variations on these plans
and like the previous poster said your employer can set criteria too.
Probably best to call the insurance co and talk to your HR dept and get
specifics. That said, my plan also required 6 mo. consecutive supervised
diet. I also had to document my exercise and behavior modifications
throughout the 6 months, a one-on-one meeting with a nutritionist and
obtain & pass a psyche evaluation. Yes, it's all frustratimg to those
of us who have dieted, lost & gained repeatedly, at least I was in the
beginning, but now that I'm at the end & in the submission process for
RNY I am so thankful because I feel totally empowered with so much more
knowledge about my upcoming lifestyle change. Hopefully your 6-mo pre-op
diet will provide you the same benefits. You can NEVER know too much about
this life-altering surgery no matter what type of WLS you have. Good luck
and stay the course to a healthier life!
— Arkin10
February 13, 2009
you will have to start over -- 6 continuous months -- one appointment ever
30 days is what they want -- good luck
— RCassety
February 14, 2009
I would recommend calling your insurance company and talk to the rep about
what criteria must be met, and then ask them to mail you a copy of the
criteria needed for approval so you can really study it and make sure YOU
know what you need and keep track of it over the six months you're working
with the dietician/surgeon. Nobody is as interested in your approval for
surgery as you are! Mine required 6 months TOTAL (Highmark BCBS through the
United Transportation Union), but it could have been broken down into two,
3-month diets (3 months WeightWatchers, 3 months supervised diet with a
physician, 3 months proof of NutriSystem, etc.) However, whatever diets I
had participated in had to be within the last two years. I had two months
here, two months there, two months over yonder, etc., so I had to do the
full six months with my surgeon/dietician, which, truthfully, I'm glad I
did. It gave me plenty of time to prepare and really learn about food and
how it works with my body. One piece of advice is if you are required to
follow a documented diet and exercise program, but your 6 months consists
of primarily working with a dietician, make sure the notes from the
dietician regarding your exercise will fulfill the exercise portion of the
requirement, and that the dietician is making notes regarding exercise in
each monthly report. Six months isn't so bad, but to find out in month
seven that you aren't approved because you haven't met the exercise
requirement would be quite unpleasant!
— wenniewo
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