Challenging Insurance requirements?

Hi Everyone!

    Not sleeved yet...but have made the decision to start the process. I have BCBS PPO (Michigan) I do believe they have a requirement of a consecutive 6 months of diet supervision through your PCP that has to be documented.
    Has anyone challenged this and was able to forego this requirement? I feel this is a ridiculous requirement. I am 47 years old and have been overweight my ENTIRE adult life and have lost and gained pounds over and over again! I have been on diets supervised and otherwise...I am an educated healthcare professional and I KNOW the drill! If I believed I could do this without the surgery...I would! 
    I am currently residing in China (husband's job) and all my new insurance info was shipped to my house in Michigan. Just from reading the boards here , it sounds like this is a requirement but I have not read if anyone has challenged it and won...if there is ...can you let me know any inside info on what you did to help accomplish this goal? Also, I do believe I have a hiatal hernia (been acting up a bit) and I head back home at the end of February and plan on getting it checked out. If I need surgery, will insurance cover both at the same time instead of two seperate procedures?? It would probably save quite a bit of money and recuperation time (for me!).
   Thanks for any info or insight you folks can provide...it is much appreciated! I love this site, it is so full of valuable information!!!         

You may want to call your insurance company and get more information before you make any assumptions. Also, could your doctor document that you have already been trying to lose weight for more than 6 months, like you say? I don't know how that works, because I'm self pay.

Good luck!

 I just looked at my BCBSOK PPO and they no longer require a 6-month supervised diet I did my 6 months and was sleeves on the 15th of Nov.. good luck

Usually they do the hernia repair and sleeve at the same time. I had to give permission if they found one to repair it. No hernia though.

Hi, I have BCBS Virginia and no six month diet supervision is requested. i haven't been sleeved yet I have to see the nutritionist today but my surgeon and insurance coordinator said that it's not a requirement. My BFF also has the same insurance, with no medical problems, besides knee pain, she didn't even have a PC, but she was approved in no time. I hope this is helpfull.

Honestly, I would think that by the time you challenged it and potentially won, it would be 6 months anyway. At worst, you lose and then still have to do the 6 months after delaying by trying to fight it. You're far from the only one here who feels this way, but in the end I think just sucking it up and doing it is probably for the best.

Thanks for all the input... I can only hope that BCBS of Michigan has gotten rid of this asinine requirement! I wish I had the coverage of benefits booklet here just so I could look it up! Their internet site isn't any help either. They snail mail you a pin number to access it as a member!
I haven't told the whole story. Currently, I reside in China. I come home at the end of February for 6 Months! Then...I return. I was hoping to get the surgery while home, recuperate, get acclimated to the sleeve; and return to China after Labor day (my husband's job is there).
 I already have a scheduled appt. with my PCP on the 27th of February. I plan on starting the process then... bu,t I also have this hernia and if it needs surgical repair, why not do both procedures at the same time?? It seems stupid to put me through two surgeries within six months of each other and I do believe it would be more cost effective??
  I just find it incredibly insulting that the insurance companies think we haven't attempted to diet or done anything to get the extra lbs. off! I have dieted my whole life...I am over it! I think the sleeve is an excellent tool to assist me in reaching a sensible weight. Thanks for the advice and listening....   

The 6 month requirement was waived for me because I had a BMI over 50. I don't know if that applies in your case but if it does I would call BC and inquire about the waiver. Good Luck!

Hi!  I live in Texas and have GEHA insurance with the same 6-month doctor supervised weight loss requirement.  My insurance company has been paying for expensive procedures and medication for treatment of high blood pressure and heart disease for 15 years with a full record of my weight history thorughout.  You would think they would see this as confirmation of the medical necessity of this procedure and also as an opportunity to reduce their costs over time.  But, I'm told by my surgeon's insurance pro that insurance companies rarely waive that requirement (in her experience).  So, I'm in my third month of the 6 month requirement and I'm trying to use the time to just educate myself with regard to the sleeve and life thereafter.  Do you have a doctor in China that could begin the weighing/documenting and then pick it up when you're home?  I wouldn't think it would have to be the same doctor, but I could be wrong. 

Anyway, hang in there.  You are not going through it alone!

 I also have BCBS of MI.  I had my surgery last november.  I did not have to do anything special to meet the 6 month requirement.  I had diabetes and several other co morbidities so I Could meet the lower BMI requirement.  MY PCP documented my weight at every visit, and my challenges and successes with the ADA diabetic diet.  They never asked for anything more.

My approval went through very smoothly with no problem.  Check with your surgeon and PCP, they may have the documentation you need already.