Question:
Can someone with BCBS please help me out..they have changed their policy

I went to my first consultation and the nurse Terry at Dr. Reinhold's office gave me a paper that states BCBS's new policy concerning wls...the new ploicy states that you have top be on a diet supervised by a doctor before you can even submit anything to them for wls. Back in August 2000 my Dr. prescribed Xenical for me but the insurance wouldn't pay for it. It would cost me $150 a month for the xenical and I really can't afford that. I'm thinking that my Dr. can use that in my letter to the insurance company. Terry also told me that she is dealing with a few patients with BCBS that have to go through appeals. My question is if anyone with BCBS that has had the surgery in the last few months can tell me what they did to get approved. I know that I need a letter from my doctor and I will probably need a diet hstory and maybe even a letter from me. CAn some one please help me. I have an appointment with the nutritionist tomorrow and an appointment with the psychologist on June 11th. I really want this surgery so really need to get some help or input from someone that has dealt with BCBS.    — TYISHA B. (posted on May 28, 2001)

May 28, 2001
I have BCBS of Tennessee and I had no problem getting approved. My doctor submited the form, and then about 4-6 weeks later I got my pre-approval, now my surgery date is set for June 26th of this year. {Next month}
   — jessie R.

May 29, 2001
I have BC/BS. I am lacking one letter from my doctor concerning the last time I was treated for my weight in order to be approved. I had to appeal even though I wasn't officially denied. Long story...anyways...BC/BS in the meantime sent me a criteria list which has an and/or list. If you would like a copy, you only need to call customer service at 1-800-672-7897.
   — S S.

May 29, 2001
A friend of mine was just recently approved by BCBS and was worried about the same thing. She has talked to her doctor about losing weight and was even on the different perscription WL drugs at one time. She has gone to Weight Watchers off and on for the last 11 or 12 years. But she didn't have a record of weigh-ins with the doctor. I suggested that she see if he would add the weigh-ins from Weight Watchers (from her record book) to his records because she had the dates right there in the book. He did. She also had a letter with the same documentation from her chiroprator. It was enough to get approval. Ask your doctor if he could do the same for you. What they really want to see is if you have tried other avenues before having surgery.
   — livnliter

June 6, 2001
I was approved and I have BCBS (PEEHIP) of Alabama. I had my history from my primary physician, weight loss history for the last couple of years, and my weight loss surgeon's recommendation. You will be surprised to find out how many times your regular doctor has recorded your weight and questions asked about weight loss. Any mentioning of weight loss will help.
   — [Anonymous]

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