Insurance question

Ok, this question is for Jen or anyone else who has Wellmark Blue Cross and Blue Shield. Do they really require that you have documented proof from your PCP that you were dieting for the 3 yrs before requesting surgery and failed to lose weight? I went to my doctor when I decided I wanted WLS and we discussed all the other diets that I have done and failed. We also discussed the fact that I was on Atkins (which I discussed with him when I started the diet) for over two years and couldn't lose the weight. I asked my PCP to write a letter of recommendation to the surgeon telling him this. Also, I have been to this doctor for other weight related things like high blood pressure etc. but he never once told me that it was because I was overweight. I think he figured I knew that. He has never specifically put me on a diet because I told him I was dieting already. I have not seen the letter my doctor sent to Covenant but I know it's two pages long. Now I'm starting to get worried that BC/BS won't accept this and approve the surgery. Anyone have any thoughts? Please tell me that it's not that strict..... Leslie

I have Wellmark BC/BS the Blue choice plan and I didn't have any trouble getting approval. I was approved after the first letter. I sent them last 3 year of med. records, had a psych evaluation, and the letter from my PCP. I had also never been put on a diet by my physcian. Good luck!!!!! Shea

Shea, thank you, I feel much better now. I just couldn't believe that it could be that strict. I have gone and read all the remarks others made about Wellmark and it seems that everyone got approved easily. Whew!!! I know that I need an EKG (due to taking Phen-Fen for one month many years ago)...I'm wondering if I could have my PCP send me to have it while I"m waiting for my psych eval in 2 weeks. again thanks...Leslie

Leslie, I have Wellmark BC/BS Alliance Select and had no problems getting approved on my first try. I have only seen my current PCP about a year and a half. But on the forms that Dr. Coster's office gave me to fill out, I also noted all my weight loss efforts/programs going back 3+ years, including Weigh****chers, Adkins, etc. Having other weight related issues helped. (I have sleep apnea, GERD, and back problems.) It definitely doesn't hurt to call Wellmark and see how your approval request is progressing. I bugged them about twice a week and they were very nice when I called, letting me know where my request was at the time. It took about 2 weeks to get my approval letter back after Coster's office submitted the request. If you have any other insurance questions I can help with, please let me know. Hang in there! LoriW

Leslie, I'm glad that you posted this message! I have Blue Cross/Blue Shield Alliance Select myself. I am so worried that I will be denied due to the 3 year documented thing as I didn't see a doctor regularly untill October 2004 when I got serious about this surgery. I do have documentation that I have been classified morbidly obese since I was 14 though. I am hoping that this will help. I had my surgeon consultation on May 13th and the letter was supposed to be sent to BC/BS this week. Does anyone have any suggestions when I should start calling them? The surgeon's office said to wait 1 month, but BC/BS seems to be approving/denying faster than that. Thanks! Leslie, the only advice I can give you is to go ahead and proceed on your journey. You can always appeal, appeal, appeal!! Sending good thoughts your way!! Tina