Insurance ?

I am curious to know if anyones insurance required the 12 months physcian supervised diets and they were approved without that because of co-morbities? Or will I have to actually do the 12 months physcian supervised diet...just wondering if there is a way around it. The insurance I have right now is BCN but plan to change it during open enrollement to BCBS PPO, which I have been told that they require the 12 months of diet. Thanks for any information.  Amy

BCBS PPO does require a 12 month supervised diet even with co-morbidities. Have you been going to your Dr often? Are you on any weight-loss medications (Meridia). If you have been going to the Dr. often (every other month or so) and he/she has documented that you have been discussing your weight/eating/exercise, that would be enough to qualify. I am going through the process right now.  Let me know if I can be of any additional help.  Good luck with your journey. ~Sheryl

I have BCBS PPO and had no co morbs.  They were pretty strict on the 12 months of dr. supervision.  I just saw my doc regularly and reported to her what I was doing.  I was put on Meridia for a time, I did Atkins, etc. and discussed that with her.  They counted that as supervision.  Even visits where my doc just asked if I was exercising counted.

Thanks for all your info....so if I had been going to Weigh****chers and have my book that would count also towards it? I didn't go 12 months and I had stopped for a couple months and then started back up.

I have BCN and had my weigh****chers books but I had to have 12 months consecutive.  I also had co-moribities.  I believe BCBS also has the same requirements. Stacey B

BCN is very, verystrict.  I have them.  They denied the orginal request and then my first appeal.  Our union steward got involved and they ended up approving it. I did a combination, between weigh****chers and my physican.  They are very strict on the12 months.  If you do go through your doctor, BCN now has forms (available on Web-Denis) that the doctor should fill out each time you are in.  You also have to be seen every month and specific things need to be discussed.   BCBSM has the same critera.  However, they are  do not require pre-authorization. If you doctor feels you have met the critera, they will go ahead and do the surgery, submit the documentation to show you have met  the critera.  If they reject it, you have to fight it post op.  BCBSM will also do a special pre-op auth if you have not met you 12 months.  But you have to have severe co-morbidies - uncontrolled diabetes.   Most insurances are between 6 and 12 months - weigh****chers (for BCBSM and BCN) does count.                        

Thank you Dmoore. I see you have gone to Dr. Baker and that is who I want to do my surgery also. I went to the orientation already and I know 2 people that have had him for their surgery. So I was reading what you wrote me....Your union steward was able to help you? I am also in the union but I didn't think they could help with that kind of stuff. Also I didn't know that the insurances wouldn't use Weigh****chers as part of the 12 months.  Do you know what specific things that need to be discussed every month with my doctor? Also....for BCBSM I have a question to what you wrote...If my doctor feels I met the critera and the insurance rejects it is that after the surgery they will have rejected it when you say post op? I have co-morbidies but not diabetes. I have high blood pressure that I currently take 3 medicines for and I have high cholestrol, and GERD, and a hiatal hernia and I am sure I have sleep apnea but have to be tested for that still and I don't know if they include thyroid problems as part of it, plus my legs swell up all the time too.  I am going to my PCP tomorrow to see if he will give me a referal right now since I have BCN until October when I will then have BCBSM. I want to get some of the initial appointments started. But I am afraid that it will come down to that I don't have the 12 months in. Sorry for all the questions and thank you for all your help. Amy