How can I get around some of the red tape??

Does anyone have any suggestions on how I can get around any of the red tape the insurance company (BCBS of Mich) requires for aproval?  It requires 12 months supervised diet but my pcp I was going to never really documented anything about my weight or diet though he did put me on cholesterol medicine, and he does not support wls.  My current pcp however does and I only have 4 months record with him.  I have dieted for years with medical wieght loss clinic, prescription diet pills ffrom there and they wont give me records they are all about sales.  I have done weigh****chers, south beach, atkins you name it.  I just dont have what they need for the red tape.  So please let me know if anyone has any experience with this and how I can go about this and speed up my aprooval. thanks - Patti 

There's not too many people who get around the red tape. You just have to claw your way through it like the rest of us did!!  It's hard, it's stressful, it takes TIME (and we want surgery NOW), but it's the only way unless you have a rich uncle hidden somewhere or are willing to refinance your home to pay cash for surgery.  Just follow the required steps and you'll get there!!!

I have bcbsm also and I am trying to get the 12 months waived.  My surgeon has successfully gotten it waived for other patients but it depends on your cir****tances.  I had a letter from my neurologist and PCP stating that I can't wait 12 months for this surgery.  I actually have never seen the letters that were sent.  I was just told that they were very compelling.  My paperwork was sent out on Oct. 17th and on Tues. I called the ins. co. for an update.  They sent everything back because it had 2 procedure codes listed and they can only approve with one code.  So now I wait some more. 

If you have 40k laying around the house- you can get around the red tape....if not gotta suck it up like everyone else has.  This is not an emergency surgery- it is ELECTIVE.   Sorry if I sound harsh but it's the truth.

 

S=

I got thru some of BCBS PPO red tape by having back trouble. My back doctor wrote BCBC a letter recommending weight loss surgery to help my back. I have a herniated disc and 3 degenerating discs. If the insurance company could choose between back surgery and lap band, they'd choose the band just out of cost. I only have 6 months supervised diet at that time, and sleep apnea as a co-morbibity.  46.1 BMI Good luck!

Amy

I used my Medical Weight Loss Records.  I had three years worth.  It is a medically supervised diet. My insurance accepted it.  At the time I had MCARE. 

Patti - BCBS rarely waives the 12 month requirement.  By the time you fight to get it waived, you will be nearly finished with your diet documentation anyway.  Sometimes it's not worth fighting the system... sometimes you just have to accept it as part of the journey and use it to your advantage. Just keep going through your monthly weigh-ins .... 4 months down, only 8 more to go.  Honestly, the time goes by very quickly.  I know this from experience (read my profile).  If weigh****chers or the medical weight loss clinic happened within the past year, fight to get your records (they're YOURS afterall) and try to add those effort on to the beginning of your 4 months.... but BCBS requires that it be 12 "Consecutive" months, so if WW and MWLC were years ago, that won't do any good.   Use this time to learn everything you can about yourself, your eating habits, your emotional triggers with food and how you can  overcome those things - better to deal with them now than wait until after surgery.  Also dig really deep into how your body will work after surgery --- not the mental part but the biological part.  I've been doing a ton of research on digestion system, the parts of the small intestine and what nutrients are absorbed in which part - and what will no longer be absorbed once they do the surgery.   USE this time for yourself. Good luck, Pam

Thank you everyone for your replies exspecially the positive ones.  This will work out one way or another. 

I also have BCBS however min is community blue. But when I called them I was told the diet had to be supervised but not necassarily by a doctor so they said weigh****chers would count. It is supervised and takes periodic weights. Although my Dr. hasn't been seeing me for a year she wrote a letter stating that she was my current physican and that i have tried 12 months of diets and she listed them. This worked for me. You have to have a physician that supports wls but maybe your pcp would be willing to write something that states you have tried weight loss attempts in the past. I am not sure how long you were in weigh****chers but that might count as well. I know every insurance is different but you could contact your provider and see if the ww counts or if it specifically has to be a pcp.