Anthem BCBS of CA... 6 month supervised dietary program question

I’m live in Maryland but my insurance is Anthem BC BS of CA. I was wondering if anyone with the same insurance had to do a 6 month supervised program? I ask because when I decided to have WLS I asked my insurance company for a copy of the medical policy (SURG.00024), and it only states; The individual must have actively participated in non-surgical methods of weight reduction; these efforts must be fully appraised by the physicians requesting authorization for surgery. When I called the insurance company and asked how long the participation should be documented for, I was told there wasn’t a specific number but during my visit with my surgeon. I was told that BC BS requires 6 months. Does this sound right, who do I believe, how do I get the correct answer?  I also posted this in insurance, Cash Pay and financing forum.

I have the same insurance and I did have to have 6 months of documented nutritional counseling prior to approval. I believe the state of Maryland requires that as well as insurance companies. 

I will say this though....it's the best thing you can do for yourself.  At first 6 months sounded like forever to me but now I realize just how valuable that time and education are to this journey.

I know it's hard to hear at this stage....but it goes by way too fast!  It really does. You will have plenty to do during this time with specialists, tests, etc....but mostly working on changing your eating/drinking and exercise habits. You have to be ready for this surgery.

I also had to do a 2 week liquid diet prior to my surgery and at first thought that was ridiculous.  Now, as a new post-op I am so thankful for that time and the lesson. I got to the point, believe it or not, that if they'd told me I could eat anything I wanted...there wasn't really anything I would have wanted to eat. 

All of these hoops you will jump through really are in your best interest and not just some red tape for the sake of making your life miserable.  Use the 6 months to your advantage...learn all you can about this lifestyle.

Good luck to you!!  You'll do great!

I agree with you, Susie, 100%. Also, you're doing great! Congratulations! :)

Hello and congrats on your decision to have WLS. I agree with Suzie...it may seem like a huge road block, but the 6 month supervised weight loss program with the right surgeon can be a perfect amount of time to get all of your testing done and really up your education level so that you are more successful after surgery. I can't stress that enough...it's a big change and you're much better off if you're as ready as you can be. Best of luck to you! No matter what hoops you have to jump through...it's worth it!

I don't have your insurance, however my insurance Kaiser also required a 6 month program  prior to approval.  Congratulation on making the decision to do WLS.  6 months may seem like a long time but it goes by really fast.  Good luck.


Linda

Regardless of what your insurance policy states, the state of Maryland requires the 6 month supervised nutritional program.  Which trumps the policy.  But look at it this way, those 6 months gives you a chance to start changing your eating habits and the foods you eat, prepares you mentally and physically for the surgery and is a great learning opportunity. 

I have the insurance you are asking about and the answer is "No", you do not need a 6 month supervised nutritional program, nor is a requirement in MD. Some policys within BC/BS do and my surgeons preapproval office made a mess of mine by assuming it was a requirement. I insisted they speak with my company and notified the office supervisor of her employees roadblock which got things rolling again. Sometimes you have to be proactive. Good Luck! WLS 4/15/2011.