Surgeons office call BCBSM PPO and they say 12 mo diet?

I was not expecting this at all. I called the office of Dr  Cahill. The guy's name who called the insurance company for me was Tony Romeo, and he called me back and said they require 12 months of supervised diet first. Of everyone I've talked to on OH I haven't heard anyone with BCBSM say they had to do a 12 month supervised diet first. My bmi is 57.

NO- BCBS changed their requirements to 6 months from a year......call back and talk to someone else or a supervisor.  PLus with your BMI so high you might not even have to do the 6 months....call them back... Shannon

Yes, call!!  My BMI was 55 when I had my physical and I didn't have to do any supervised weight loss.  (I also have BCBSM - PPO.)  BCBS's new revision - I believe as of 1/1/08 - is that the supervised weight loss is waived if the person's BMI is >50.  I even called to verify this and to make sure the procedure I want is covered.  They confirmed it. Hope they get this straightened out for you! Gwen ETA - I don't know what I was typing!! The revision was this year.....sorry if I confused you.

Ok, so who do I call back? Should I be calling Tony Romeo at the surgeons office back or calling the insurance back myself? What codes do I need to have for RNY (lap)? Also, I haven't had a physical. Do I need a physical at the surgeon's office or would I do this with a pcp?

YOU call your insurance company and have them mail you a copy of the criteria then call that Tony guy and tell him or show him...get your physical with your PCP..not sure of the codes-call your surgeon and ask...i think it is 43644 but I could be wrong....Im not at work so I am going off memory..lol

Ditto what Shannon said... I recently got an email from my BCBS that said there was a BIG change in policy.... Call them first then they guy you talk to about the insurance... you shouldn't have to wait that long... Best of luck to you.... Hugs,

I used the numbers on the sheet that I was given by my surgeon's office to verify with BCBS that WLS and the procedure I want was covered.  (I only checked for Lap Band and Sleeve - those I know are covered.) These are from that sheet - Diagnosis code is: 278.01 Procedure codes for RNY: 43644 (laparoscopic) and 43846 (open) They should be the same, but I have corresponded with another BCBSM person who had a different code for her procedure than what was on my list and she was told it wasn't covered. I hope these work and/or helps! Gwen

Hey- I guess I do have a good memory...i got the code number rght.....Ayyyyyyyyyyy ( say it likr Fonzie..LOL

I see you live in Indiana Is your blue cross from Indiana, Michigan or Ohio ? Look at the Back of  your card and let us know thanks

I have BCN and they required me to do the 12 months too. I just took the paper from the doctors office in every month and then turned it in and I was approved in less than a week. Hope this helps.