BCBS medically supervised requirement

Has anyone else heard that BCBS is reducing their requirement for medically supervised weight loss from 12 months to 6? Supposedly each state is different, I am in Illinois. I've heard this from a few sources but the rep could not find any back up to this when she personally called to give me my second denial as there was a 6 week gap btwn two appts (and I showed proof that I was out of the country on business). I am devistated and pulling for any hope I can get.....and prepared to go self pay just because I am so ready to move on.

Just wanted to wish you all the best. I have BC/BS PPO and went through the year long doctor supervised diet/exercise plan, though it ended up being more than 15 months (due to another medical condition that postponed surgery and my overwhelming paranoia about BC/BS!!). Hang in there if you can. And if you can't good luck with the self pay. You have the best surgeon in Dr. F!! Good luck, Illini PS I haven't heard anything about a reduction in the time frame, but there was another thread on here earlier this month about it. ALSO, if you can find someone in HR who is willing to help you out, that can go a very long way. I was lucky in that I had a great relationship with the HR person for my company who handles insurance relationships and she helped me out a lot. That's a way to short cut to a higher level at BC/BS.

Tiffany~ I am sorry you are having such a hard time with the insurance company. BCBS can be a real nightmare. I am lucky enought to have a PCP who crossed evert 't' and dotted every 'i' so there were few questions they could ask in the end. I cannot remember whether I've heard that BCBS is changing from a 12 to 6 month MSD requirement. I do know they are now requiring proof of 12 months free from drug and/or alcohol abuse. Have you tried to fight the decision? Have you written your own letter of medical necessity, including any and all comorbidities you have or have had in your life, and asked your MD to rewrite it? Considered contacting an attorney? I know your date is close, but you may want to try one more time to go after BCBS. Let me know if I can be of any assistance~ Katie

Tiffany, I think that this might also have to do with the policy that your employer took out too. I have the BCBS of IL PPO plan through State Farm. We have been advised that there are no changes in the requirements for Gastric Bypass Surgery in 2006. I even made a call to the customer service number and they had not heard anything at all about the reduction of the time period for the supervised diet. I wish there was better news but I haven't been able to confirm anything. Good luck! Beth M

Hi Tiffany, I did hear of this-from the nurse running my weight loss program, but, again have heard nothing for a confirmation of such rumors. (such hopeful rumors too!) I am so sorry you've been denied-TEMPORARILY denied, at best. : ) I am now on Month 13-14 (not sure) of a 12 month program. The nurse who runs my program said he's going 50/50 with approvals from BC/BS. I did see my nutrionist, and dietician everymonth, saw a PT every 3 months and saw a therapist at the beginning and now at the end (which my appt. is 1/10/06). After next Tuesday, I will be submitted for insurance approval. I did every single thing they wanted me to do-had to do-and failed, again. At least I haven't gained back a ton of weight, but lost some 25-30 lbs. Keep trying. It's only a 6 week gap. My suggestion is to go see the doc now, then. Hell its one more month of a visit, right? or is BC/BS stating you have to do it all over again?? Can you be more specific as to why they denied you? I'd like to know if its legal to do so.