Preapproval process

Hi everyone, I am just starting to look at surgery and would like to know what the process is before you can be approved by your doctor for surgery. Also, how hard is BC/BS insurance to work with? Thanks for any info you might like to share. Denise

Hi Denise, Usually with BC/BS you have to have 12 mos. of documented weight loss attempts. Documentation must be by doctor or weigh****chers or a weight loss facility. You also have to have a BMI of 35 with 2 comorbidities, like high blood pressure, diabetes, etc... or a BMI of 40. I have BC/BS MESSA, which is the easiest of the BC/BS insurances to deal with. I had approval within one week of having a consultation with the surgeon. MESSA doesn't require the diet documentation. Oh, you will also need a psychological evaluation, but the surgeon will give you all of that info. I suggest you go to an informational seminar in your area. Good luck on your journey. Mary

Hi Mary, Thanks for all the good information. Where do you find out about the seminars you mentioned? Also, did you have a referral from your primary care physician? Denise

Look for a bariatric center of excellence in your area and give them a call. They will have seminar dates set up and you can register.

Read the fine print in your policy. I had Anthem BC/BS at first, which has been known to approve WLS, but in my case the employer had an exclusion written in. You do have to be on a supervised diet in most cases, it seems -- at least 6 months, and often 12.

Thanks for the info ladies. Sounds like I have at least a year before I may be having the surgery. I have federal BC/BC and there are no exclusions like you mentioned Kate. It says the BMI of 40 or BMI of 35 with comorbidities. It says nothing about the year of supervised weight loss attempts, however. I figured there was something you had to do to prove you were really ready to lose weight and keep it off.

Hello everyone. I am new on here and I went in for my rn visit and was so excited because I have everything done they wanted except the preopp diet and exercise which is next Tues. and my surgeon consult which was scheduled for the 11th of July and my ins papers went out in the mail today. When I got home, I had a call from the office and they told me that since my ins is Humana a form of medicare that I will have to have 6 months weight loss conseloring before I can get the surgery done. I was so close and now I feel so far away and if anybody has Humana or can relate to this please tell me how u got through it because I am very depressed. I did lose 7 pounds but for what now? I quit drinking pop which was really hard, and I even had my evals all done. What do I do now? Angry at ins., Chris

Denise, As soon as I decided I wanted the WLS I began documenting all of my daily intake, exercise time, protiens and left a space for comments and a goal I would set up for the day. When I showed these papers to my nutritionist she was so impressed and enthused about my personal actions and determinations to be successful with my WLS journey. As time went on she commented that I was one of her best patients in documenting everything. As I am still waiting for my surgery to be approved I have found that I have over ten months or more of diet and exercise documenting. It is definetly a plus for me...good luck and I am certain you will do well...Hugs, Amber

What good advice. At what point do they say you can do it on your own if you have lasted 10 months and don't need surgery? As you can see I know very little about this whole process. Thanks so much for helping out the newbie! Denise

Denise, I understood from other posts that many WLS people had to do a 6 mos. super- vised diet before being accepted for WLS. As I had been doing it on my own and my nut really liked my documentation I just continued working with her and bringing up any concerns about my ongoing plan. I had been seeing her every month for the past year and a half and weighed in each time and she documented my progress as we went along (including a graph of my weight loss efforts which were indeed "efforts"). I am insulin resistent with my diabetes and it shows. Medicaid had approved me in March of 06 (they are my secondary insurance) and Medicare hasn't even begun accepting people for WLS at this point...at SMDC in Duluth but we're expecting good news at any time (fingers crossed!). Your insurance may not need to require you to do a 6 mos. supervised diet and even if they do it would probably be to your advantage on a personal level as there would be plenty of time to focus and re-focus on your WLS vision that you have for your- self. 'sorry to go on so. We all have our paths to follow and we will eventually all be on the losers bench together. There may be delays...embrace them and count your blessings that everythingg is coming along...Hugs and don't hesitate to reply...thank you...Amber