MD BC/BS Requirements

Well, the good news is that I finally found a loop hole in my corporate policy that allows me to meet a strict set of criteria in order to qualify to be given an exception in our PPO plan to allow me to be covered by my benefits for the WLS...yay!  No more self pay!
The bad news is, I live in MN and don't know what the Maryland BC/BS pre-surgery requirements are.  I believe that the requirements I was given by my company are very closely related to what BCBS of MD follows, but I was wondering if anyone can clarify for me.  I have listed the details below for starters.  I am mostly wondering if I have to go through this process twice (once to qualify for my company and once through BCBS).  I will have to wait until at least 11/1 to get official approval because that meets the tenure requirement they have.

Any help is greatly appreciated!

Jessica

• medical doctor must provide a written opinion regarding the necessity of the procedure
• history of other options which were attempted unsuccessfully  (this tends to require a specific period of time immediately prior to the approval of 3-6 months or so – does that apply?)
• detail the post operation treatment plan

I have MD BC/BS and am currently in the "pre-approval" process.  My only requirements from BC/BS are that I have a letter of medical necessity and that I be on either a six month doctor supervised diet or two three month periods of a paid weight loss program such as Weigh****chers or Jenny Craig.  I am doing the six month doctor supervised diet, which in all actuality is just following the plan that my NUT gave me at the bariatric clinic and then going in to my doctor's office once a month for monitoring and weigh in.  My PC is going to give me a write up in October (the end of my six months) to prove that I attended my monthly weigh-ins and did, in fact, lose weight.  He provided the letter of medical necessity as soon as I found out I needed one, and since I am a heart patient my cardiologist also threw in a letter of medical necessity just to keep me covered.  :-)

Thank you so much for your response.  That is basically what I am expecting, I just thought I would see if there were any unexpected snags that I might run into.  I don't be one of the people that has to come on and post about how I was denied...it'll never happen! 

Oh, I so know what you mean.  I've been so careful to document everything everyone has told me, from my surgeon to the insurance company.  I have names...so if I have to, I have someone I can refer back to.  Good luck!