All Blue Cross members (not federal)..please "weigh" in!! (NO PUN INTENDED)

Hey,   I happened to be told today by office staff that "ALL" Blue Cross patients need 6 month documented weight loss program prior to any Weight loss surgery. Problem is..I called my insurance and both employees in Pre-certification and Pre-determination said that is not true. The literature was faxed to me today and there is NOTHING in it about "6 months" or "documented".  I was wondering, if this isn't maybe more for the sake of the Doc..ie; he wants to be able to say I have tried and failed and it is documented...which in that case, would NOT be a requirement of the insurance but the practice's requirement..   What gives..where do I go from here...I'm going to have to challenge the staff on the 2nd day I call?? Great!! (sarcasm) I don't want to be the Pain in the buttocks patient they all talk about and hate, but I would like to move forward....   Has anyone come across this before?    Alicia

Hi Alicia, I know you told us BCBS "federals" not to weigh in, but I don't follow directions too well.    My doctor's office tried to pull the same okey doke on me, but I REFUSED to let it happen.  I brought in all my paperwork from the ins comp and made the ins coordinator call with me in the office.  Then, they (the doc's office) claimed that it was really their policy and they "strongly" recommended that I follow it.  Boo!  I REFUSED.  I had my surgery 4 months from the time I visited for the info session.   So, IMO, I would fight for your rights.  Be the pain in the butt and get results.  Best of luck.

Yes, my sister said to be the squeaky wheel too!!! But ...get this...the reason I said "not federal" is because she did mention ALL BC/BS EXCEPT Federal.....so that office wouldn't have hassled you anyway, but it is interesting that you mention the EXACT point I was thinking, is that it is THEIR practice NOT the insurance...hmmmmm.......Very Interesting...okay let me see who else weighs in...Thank you SOOOO much!!   Alicia

Hey Alicia,  I dont know who your employer is but I am with the state of Maryland, Carefirst BC/BS PPO and in looking at the policy, my plan does say, "6 mos supervised weight loss" or two structured diet programs for 3 consrecutive months"  I was looking for words that indicated those things were "suggested" and not mandatory, but couldn't find any.  It actually says, "patients who meet all of the following criteria" that criteria was the supervised weight loss.....Anyway, maybe you have a different policy than I do.  Either that or you were misinformed by the employees.  Hoping you don't have to wait, even though I do.  Good Luck!!  C 

Hmmm,  No actually my policy , which she faxed, has none of that wording...that was another question I had, maybe the employee at doctor's office, assumed because I had Blue Cross and other Blue Cross require 6 months..that mine would too, which would be an acceptable assumption....mine is Anthem.The insurance personnel did say it was like a pizza and my employer "picked which toppings it would allow", and that  WLsurgery was covered, so maybe..along with the picking of toppings, the employer can add qualifiers to the coverage.....Okay, I love getting more pieces to this puzzle...   Alicia

I guess then it depends on the size of the company as well as the state..I live/work in Maryland but my company has Blue Cross Blue Shield of Illinois...Here is a link to their policy for Surgery for Morbid Obesity http://medicalpolicy.hcsc.net/medicalpolicy/home?corpEntCd=I L1&corpEntCd=IL1&ctype=POLICY&cat=Surgery&path=/templatedata /medpolicies/POLICY/data/SURGERY/SUR716.003_2007-07-01#hlink

It states 6 months of a supervised weight loss as well..

Soo, My advise would be to call the surgeon you choose to see what they have to say about it. They have handled 1000s of surgery and have dealt with practically every insurance..so they would be a very knowledgable asset.

What Insurance do you have?

Here is a link to another BCBS site

http://notesnet.carefirst.com/ecommerce/medicalpolicy.nsf/vw webtablex/5f7d5d5252a6a6b2852573d9005aeae1?OpenDocument

Yes, BC/BS was very clear about this policy when I went through this 3 years ago. AND, because I didn't follow it properly the first time, I had to repeat it :(   If your policy requires it, and my BC/BS did, you must present documented records for a "6 months CONSECUTIVE  PHYSICIAN SUPERVISED weight loss program" No weigh****chers, no nutritionists or dieticians.  The appointments must be made with a doctor, hopefully your PCP. They must be 28-30 days apart and you cannot miss one appt or go beyond the 30 days. (that was my mistake) At every single appt, you must discuss and have your doctor document height, weight, BP, any obesity related conditions, treatments, and diet.  Best of luck.

Hi Alicia, I am/was with BCBS or Illinois.   My surgeon's office insisted (and in fact gave me a letter from BCBS of Ill showing) that I would need a 12 month Dr. assisted diet.    I informed them that I only needed 6 months.   They insisted that I would need 12 but asked me to provide proof.   I got the paperwork and also called and a got a name, date, time, and number of the person I spoke with.    I took it all to the surgeon's office and they they were thrilled. Believe me....this is not a requirement of the surgeon.   But also remember that even the same insurance company (ie BCBS of Ill) will have a different policy based on the employer.   So there is no possible way the offices can keep up with every single policy.    Don't be rude...but don't be shy.  If you have documentation showing that you don't need the diet...then show it to the practice and they will be thrilled. Good luck...

Hey Dave...Thanks..  I never even considered the Doc's office might be glad that I don't need that extra step. The medical  policy faxed to me was from Pre-determination office, and the co-ordinator even wrote, "Give this to your Doc and have him fax it when he has filled it out" and it says NOTHING about 6 months anywhere on it....  I sort of hate that I assumed the Doc's office wouldn't work with me...that's a shame, but lately "customer service" in ANY industry is lacking ANY sense of service..ya know??  Alicia