BCBS of Michigan

Anyone have problems with their PCP's letter for BCBS?  My PCP takes the "12 consecutive supervised diet history" very literally, and won't write that in his letter.  He has been my pcp for the past 20 years and every time I see him, we have discussed my weight and different diets.  He even put me on Phen-Fen for a while and he supports me having this surgery.  But won't include that statement in his letter.  Barix has told me that BCBS will not approve the surgery without that specific sentence in the pcp letter.  Any advise???

I had the same problem she would not use the word consecutive but she would say that I had been under her continous care care from 1998 till present date for my weight  and listed everything that we had tried. And I was approved. I hope this helps. Deb

Have you read the specific requirements for BCBS's diet documentation?  It's more than just "dieting".  Your supervising doctor must be assured you are not only following an altered eating plan, but also document your physical exercise efforts, nutrition counseling, psychological counseling and pharmacutical therapy as well.   BCBS will not accept hand written notes from the patient as proof.  However, in some instances 12 consecutive months of Weigh****chers (or other structured programs) that were recommended by your doctor can be used.  The requirements are pretty strict and our doctor could get into serious legal trouble if he makes statements that may be construed as false. My situation was very difficult for me to accept at first.  I had completed 12 months of dieting ... talked to my doctor during 8 different visits throughout that year.  Even brought in my diet log, exercise chart, etc and discussed possible diet pills.  I was confident that I'd fulfilled my 12 month diet requirement.  But when my medical chart was reviewed by my surgeon's office, they found NO notes in my chart about my diet efforts.  Just a single entry halfway through that said "patient continues to diet."  Not good enough for insurance approval.  And BCBS would not accept a PCP letter that stated a full 12 months of diet history without the proof to back it up - the notes needed to be in place in my medical chart. So I started over with ANOTHER 12 months.  But this time I went through a program recommended by my surgeon's office.  I weighed in every month, had a session with a RN who was also a nutritionist and a personal trainer.  He took my blood pressure, pulse, weight and body fat percentage ... everything was recorded in a chart that the insurance company would accept.  A copy of that paperwork was given to my PCP at the end of my 12 months and my PCP could honestly state in his letter of support that I had been following a diet for 12 months.  It was a really tough 12 months for me emotionally and the waiting drove me nuts.  But with 10 days of finishing that 12 month diet requirement, I got a call from the surgeon's office to schedule my surgery.  So it was all worth it in the end. If you do not have a written copy of BCBS requirements for the surgery, call the number on the back of your insurance card and request a letter be sent to you personally.  This will be your roadmap for what you need to accomplish and since it's in writing, there can be no miscommunication with all your healthcare providers.  Everyone will be on the exact same page and know exactly what needs to be done.  So my advice is to call your PCP on Monday and set up appointments for the next 12 months.  Get started immediaely and be proactive with your diet.  It's going to be a long hard year of waiting ... but use it to your advantage to learn as much (more) about this surgery as you can and prepare yourself mentally for the surgery.  On an up-note.  I've heard that BCBS is planning to change their 12 month requirement to 6 months.  So start now, but make some calls periodically to see if the change has taken effect for your specific policy. Good luck, Pam

OMG!  Pam!  How are you doing?  I am so sorry I missed your big day.  I'm not sure how that happened.  Hope all went well and congratulations on being on the path to health and well being. Jenn

Hi Jenn - Thanks for the well wishes!  I'm feeling better and better every day and seem to be recovering quickly.  No problems with tolerating food.  But still struggling with getting in all my water and protein, but I do better each day.  Down 6 pounds since surgery on Tuesday --- 21 since the liquid diet started. I've been off pain meds for a few days now, so I'm finally able to drive again (which was a big incentive to stop the meds).  I think I'll hit the theater this evening just for the fun of it.  :) So glad to be a loser! Pam

Pam, Just curious - I have BCBS MI also, and was wondering where you heard about the possible change to a 6 month requirement?  BCBS previously had a 6 month requirement, then changed to 12 months some time back.  I have ~11.5 months of formal program documentation and I've had all sorts of grief over it (not the full 12).  Any idea on when they might return to the 6 month criteria? Thanks in advance.

Last month at my Nutrition and Nursing Class (pre-op) the nurse mentioned that BCBS would be changing to the 6 month requirement.  Of course every policy is different, so who knows if that's across the board or with just certain ones.  But it'd be worth a call to see if your policy has changed.  Or maybe it'll be something that happens in January. Good luck, Pam