Info./advice wanted re. BCBS HMO IL process

Hi, I have just started to pursue weight loss surgery. I have the support of my primary since I have a BMI of at least 42 and high blood pressure. I was told by my primary that I would need to see a dietician for 6 mos. before anything could be considered per the HMO. Today I received a phone call from the office that the time line was a year of supervised weight loss trial and exercise program. Not sure if I am getting the run-around or what? Spent 1 1/2 of the past 2 years at Jenny Craig which I can validate. Before I run around getting proof for all this stuff does any one know if all this is even needed. Looking at some of the insurers section reviews and I'm getting mixed a review. Anyone have any information regarding as to what is the best way to proceed to make this happen? Thanks a mil to any info. you can provide me with. Debbi

Hi Debbi, I didn't have a problem with BCBS HMO. In previous posts I have said that it is the medical group you belong to that actually makes the decision for you to have the surgery, BCBS only pays for it. I went to my doctor in May, saw my surgeon in June, went through all the tests and had my surgery in September. If you have any kind of documentation stating you spoke to your doctor about your weight on different visits, any comorbidites, you should be good to go. By the way, I was on Weigh****chers and the documentation wasn't good enough because it wasn't a medically supervised diet. Hope this helps. Laura 266/203/125

Hi Debbi, I just posted a response to someone else who asked the same sort of question you did. I switched from the HMO to the PPO, but continued to work on the requirements for the surgery. Just before I switched my PCP told me that the HMO required a 6 month supervised weight loss effort and a weight loss of at least 10%. The PPO requires a 1 year supervised weight loss effort and a 5 year documented history of MO. AND, overall the requirements have changed at least 3 times since I started watching them a little over a year ago - requirement morphed from no physician supervised diet into a 1 year supervised diet. So, you need to be careful/vigilant and continue to check on the requirements periodically. You really need to work with your PCP on this as with an HMO the medical group your PCP is a part of will be the decision maker on this, though I believe that BCBS provides the guidelines. I wish you much luck! Illini

Blue Cross just changed their policy as of JANUARY 18!!! Whipee! Here is the URL of thier policy: http://medicalpolicy.hcsc.net/medpolicies/home?corpEntCd=IL1&path=templatedata\medpolicies\surg\data\SUR716.003_2005-01-18&ctype=MEDPOLICIES-POLICY&cat=SURGERY Basically, as I read it, is that if you are sick enough to meet their requirements, you will probably be dead by the time they approve you. I suspect to hear any day that they will be rejecting me.