Insurance Questions..again lol

I know I can take this up in the insurance forum but the RNY section seems to be hopping more :-D   I have CBA blue which is a carrier with BCBS of Vermont thru my employer. During open enrollment when I got my book (in 2011) it stated the typical guidelines like seeing a nutritionist, psychiatrist,etc but it didn't state that I had to do any "X" amount of time of weigh ins. On their website (updated 7/1/13) it states I have to do 6 months which I don't mind because I can try to lose as much weight as possible before surgery.   So my question is, due to having co-morbid conditions(insulin resistance,PCOS,sleep apnea,high blood pressure,etc) and a BMI of 51.7 at my first appt., would they make exceptions? Are they just general guidelines or are insurance companies usually cut and dry.   Has anyone ever gotten surgery early without "mandatory" weigh ins?  My dietitian and psychiatrist both cleared me for surgery. I don't have to do any other pre op diets, classes/meetings but I may need an endoscopy however it's not required by my insurance.    I don't really care and frankly like I said, I would prefer the 6 months. It gives me time to mentally prepare myself and physically lose weight. 

I have BCBS of Illinois no weigh ins.

If their website says they require 6 months, then they are NOT going to waive it.  unless, of course, it specifically says it is only required for certain BMIs.  To be honest, with a BMI over 50 (and mine was as well -- almost 57 -- so this isn't a slam of any kind), they are actually MORE likely to want the 6 months to be sure that you can follow through. I'm confused, though... Is it specifically "weigh-ins" that you don't want to do or are you just asking whether there is any chance you will get out f the 6 month requirement entirely? 

(Keep in mind that other insurers may be very different, so just because someone else says THEIR insurer has no specific requirements doesn't mean squat about YOURS). 

Lora

I know I may sound nutty lol but I want the 6 months. I don't want to rush this seeing that its something life changing ya know. I want to make sure I am fully prepared!

My dietician said yesterday that the more weight I can lose, the better off I am recovery-wise.

And I should clarify, I know I said previously I didn't care but as much as I want to lose this weight like yesterday, I want to make sure I have all my chicken lined up first! 

 

I understand wanting to lose the weight quickly, but I think you are right to want to be properly prepared.  Mental preparation is really important.  Many of the people we see here (and I see professionally) who struggle with WLS weren't really ready. Yes, the more weight you can lose pre-op, the easier your recovery will probably be (no guarantees, of course). 

I also think it is really valuable to see a counselor to deal with any psychological/emotional contributors to the excess weight. Even if you don't have a history of abuse or trauma, most of us have some kind of emotional contributor, even if it is just that we use food to deal with stress.

Lora

Obviously every insurance company is different but from my experience between my own personal journey and working for an insurance company they don't make exceptions. My BMI was 66.9 and I had high blood pressure and mild sleep apnea. My insurance company required 180 days of supervised weight loss which translated to seeing the PA once a month to track my progress. I don't know if it's an insurance requirement or the doctors requirement but some places have you lose a certain amount of weight in those 6 months too. My program just required to scale to move down, even if only 1-2lbs a month. In addition to that the traditional psych eval as well as seeing a dietitian was also required. Now the hospital that I went through had their own program and requirements as well as the doctor having his own requirements. I had to attend at least one support group meeting, two group meetings with the dietitian, a scope, chest X-Ray, extensive blood work, cardiac clearance as well as a pulmonary function test. It was overwhelming at first but I am SO glad my surgeon was meticulous with everything because it made for a smooth, complication free surgery and recovery. There are people who don't have any type of insurance requirement and don't have to wait the 6 months. In my opinion, even though it seems far away (well, it did for me anyway lol) I feel if the time is used wisely the 6 month waiting period is a good thing. Take the time to educate yourself further, attend a support group or two, talk to people who have had this done, start making the lifestyle changes now so it's not such a shock after wards (i.e. get used to taking your vitamins even if it's just a multi for now). I went out and bought baby utensils and started using those to adjust to taking smaller bites and making sure I chew chew chew. I also stopped drinking with my meals which was freaking hard! Also losing weight before hand and getting as healthy as you can will help make for a smooth procedure and recovery. 

Just my two cents! :) Good luck on your journey!

I have Anthem Blue Cros Blue Shield in Indiana.  I too have several co-morbidities and my BMI was 67.7 in January of this year. My insurance required the full 6 months of going to my Bariatric center. No exceptions to the fact that my BMI was so high.  During this time I had to have 3 appointments per month, 1 with the nurse, the dietician, and the fitness trainer.  This helped me tremendously on educating myself on how to eat, what exercises I could do, ( I have arthritis really bad and use a cane to walk).  In addition, my insurance required me to attend 3 support groups during the 6 month period, but all of these things were excellent preparation for my surgery.  

I just had my surgery 11 days ago, and feel so much better.  I have also been taken off of 1 of my blood pressure meds (I took 2), & my gout medicine. I feel great.  

Best of luck to you:)

When I first started this journey I thought 6 months was an eternity but I learned so much during that time I realize now how important this requirement is.  It gives you time to establish some habits that will help you after the surgery as well as losing some of your weight beforehand.  It actually took me almost a year before I had everything in place.  But the changes I made have definitely helped me now!  Hang in there, do what's required and you'll be on your way before you even realize it.  Good luck!

Thank you all for the great responses! 

Not only are insurance companies different, but POLICIES differ. I have Aetna PPO with a 100 deductible and a max 1500 out of pocket and they DO cover RNY and one or two other surgeries and then band adjustments on my policy, not new bands. I have a friend with Aetna PPO and she has a 500 deductible, 2500 out of pocked max and NO WLS, but they will adjust bands for those that already had them. 

We're in the same city, working for competing companies and that much is different that I know of. And mostly because she had the band, hates it and wants RNY and has been vocal about it.