Trying to understand the BC/BS approval process

I went to a seminar at Lakeview and really enjoyed it. I have sumitted the info for the Surgical specialist to look into my insurance. I have BC/BS of Texas and would like to have WLS due to my health deteriorating. I was told that both the Lap Band and Bypass was covered, BUT and we love the BUT, I need to have 12 months of diet supervised by a doctor. I was seeing a doctor for more than 6 months and he left to go to Canada and I am in a real spot. I suffer from Hypertention, Sleep apnea and COPD. Now I am looking for advice and help as to which way to turn. Any information would be appreciated. E.B.

Hi Earl: I have BCBS of Alabama and had to do a 6-month supervised diet. It is my understanding that they BCBS in general is pretty strict about this requirement and are not known for approving without that requirement being fulfilled. You should still be able to get your records from whatever office the MD was practicing out of. I would go ahead and get those to see if the documentation is adequate. They generally want a weigh-in, actual visit with the doctor, NOT just getting weighed and the doctor must write a progress note at each visit documenting your diet and exercise regime and any progress or lack thereof. The visits MUST be consecutive and you cannot skip any month. Your best bed that this time is to get a hard copy of your exact policy from your insurer regarding weight loss surgery. Then you will know exactly what you need to do in order to have a good chance of getting approved. I followed their every requirement and got approved within 12 days after submitting my paperwork. You need to get a primary physician as soon as possible and start your supervised diet. Good luck with everything, Angela

If I did go on a supervised diet and lost say 35 pounds, would I now not meet the requirements for WLS? If you do not know the answer to this I will call BCBS.\ Thanks, Earl