Anthem BCBS of CA... 6 month supervised dietary program question

I’m live in Maryland but my insurance is Anthem BC BS of CA. I was wondering if anyone with the same insurance had to do a 6 month supervised program? I ask because when I decided to have WLS I asked my insurance company for a copy of the medical policy (SURG.00024), and it only states; The individual must have actively participated in non-surgical methods of weight reduction; these efforts must be fully appraised by the physicians requesting authorization for surgery. When I called the insurance company and asked how long the participation should be documented for, I was told there wasn’t a specific number but during my visit with my surgeon. I was told that BC BS requires 6 months. Does this sound right, who do I believe, how do I get the correct answer?  I also posted this in insurance, Cash Pay and financing forum.

I have BCBS of Texas and yes, I had to do 6-months of supervised nutrition.  I griped and moaned the entire 6 months because I was READY to have surgery.  After the surgery I was glad I had been through the nutrition advice.  I knew why I had to do what I had to do to be successful and I understood the surgery and the diet a whole lot better.  I am now glad that they required the nutrition supervision.....after all.....it is a whole new world !!!!   Good Luck !

Thanks and congratulations on your weight loss,
I paid for the 6 months as well as 3 post-opt sessions. I do believe ALL the sessions will be most beneficial, I just rather have 3 pre-opt and 6 post-op sessions. The current setup sort of reminds me of my first diet program, were they give you all the upfront support but when I reached my goal, there wasn’t enough support given to maintain the weight loss. Besides I am READY to have my surgery. I have my second dietary visit on 4/19 and I will ask Devorah(the nutritionist) if its possible to swap out the sessions. Either way I’ll do the months because it will be beneficial.  

 

I have Anthem BC/BS of CA...my surgery was 2 1/2 years ago...and no I didn't have to do a 6 month supervised diet. I don't know if their policy has changed since then.

Thanks, this is confusing the insurance company say one thing and the surgeons office say another.

First, figure out if the six month diet requirement is required by your insurance or by your surgeon.  If it is your surgeon, CHANGE SURGEONS.

Second, if it is your insurance, find out whether your insurance policy is fully funded, and if it was "issued, amended, delivered or renewed" in CA.  If so, your plan should be covered by the DMHC rules.  You can file a grievance with the DMHC and they will order the insurer to waive the requirement.  http://www.dmhc.ca.gov/aboutTheDMHC/org/boards/cap/Bariatric REV.pdf

See also http://www.asmbs.org/Newsite07/resources/ASMBS%20Position%20 Statement%20on%20Preoperative%20Supervised%20Weight%20Loss%2 0Requirements.pdf

Diana,

Any chance of being able to get UHC (in South Carolina) to waive my 6 month diet requirement?? I want the DS so I can get rid of my diabetes, the weight loss (I am a "lightweight" about 100 lbs to lose) would just be a plus.

Thanks,

Beth

You can always try to appeal it - file a grievance with your insurer as well as your state Dept. of Insurance, and cite those documents.  There is NO evidence that the diet helps and plenty of evidence that it hurts by delaying access to medically necessary treatment.

Hi All

I am new and currently going thru the 6 mnth program that is required thru my insurance, now for my insurance the only way around it is to have some other major problems documented from previous DR. visits that says you need the procedure right away to help the other concerns.

I am anxious but the 6 mnth program really gives you the opportunity to prepare and research your new life style changes.

Will keep you posted....I do have my surgeon consultation appt and psych appt tomorrow, although my 6 mnth program is not over yet....

JG