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

Roni, I read your response and got a little concerned.  You didn't knowingly "miss" an appointment.  what if the docs office scheduled more than 30 days apart?? How can that be your fault?? I am concerned because I had one appointment on March 5 and then April's wasn't scheduled until April 16.  Should I be worried that I will get denied??  C

Keep in mind that was 3 years ago when insurance companies were still relictant to approve these procedures at all, but yes, there were very strict at that time and my appointments were like you mentioned, one would be march 5th and the following would be april 15th; or, I had an appt scheduled about a month apart but if something came up, I would reschedule it for a week or so later. I assumed that as long as I had one in march and one in april, one in may, etc., that it would not matter about number of days apart, but that's the 'consecutive' part of the requirement. So at that time, and for my insurance company, it was unnacceptable to miss an appt. because they had the wording consecutive in their policy. They sent it to me and the wording was exactly as they explained "six months consecutive physician supervised weight loss program". They would not even allow the appts to be with a dieticion, nutritionist, or WW, it had to be a doctor. So read your information carefully to see if they are still being that strict. When I had to repeat the 6 months, I went to my PCP and scheduled 6 appt's ecactly 28 days apart and this time I didn't miss a single appt. - I was approved in 3 days :)  

Hey-   That little laughing puppy is SOOOOOOOO cute! The woman at office I called mentioned the every 30 days...she didn't emphasize it like "do or die", but she was pretty serious about it.... I assume (although that may be a stretch) that if PCP office documents the appts made on their terms then how could it be your fault?? So at the end of the 6 months , if all parties involved got together and supported your hard work......maybe  Insurance company won't hard nose you!!  Keep us updated..   Alicia

As for every 30 days, they require 6 months of supervised diet not matter what day of the month you go either to WW or your PCP or GYN or Nutritionist. The visits should be for weight management, so for example if you go for your allergy shot in May and they wigh you as well, it wouldn't help. Also I had BCBS (Empire) and tried sending my paparework earlier in the fourth month since insurance was changing. Unfortunately DH's employer had exclusion policy and they denied it, however if you are interested to mkake sure if you r policy requires 6 month or not, ask the insurance company for the specific link on website nad make a copy of it. DOCUMENT DOCUMENT DOCUMENT everything and remember that even non federal BCBS have many different policies and different coverageas. They might or might not rewuire 6 month, Ellie

Boy they really get ya! I was also told by Doc's staff that if you are denied, it is 6 months before you can appeal (or I guess re-apply), which actually wouldn't be so bad, because I guess in that 6 months you could start the weight loss program and kill two birds with 1 stone!!  Personally I just don't even undertand the whole issue..I mean "lose weight" before you are going to "lose weight"??? It's like telling an alcoholic..you'll have to quit drinking before we can help you quit drinking!! AAAARRRRGGGGHHHH!! - Alicia

I totally understand what you mean and not that I want to defend the ins. companies, but the idea is that there are no short cuts. People still try to get WLS because they think its an "easy out', so the insurance company wants the documentation to prove that a strict physician supervised weight loss program will not benefit us, therefore, we need the surgery in order to become a healthier person.