BCBS of Nebraska

The best thing to do is to request the eligibility form.  There are many different types of insurance through BCBSM.  Just call customer service and ask for the eligibilty requirements.  I don't know why they wouldn't have when you called the first time. They do still have the 6 months of documented diet listed, but none of these guidelines are set in stone.   I worked with a dietician for 4 months and was approved even though my eligibility requirement stated I needed 6 months of documented diet. Good Luck!

I have BCBS MN and they said I needed all of that too. But approved me just with a written statement of all the diets I had been on, none of it medically supervised other than my Drs. records showed consistent discussion of the need for weightloss at each annual physical for 2 years. I guess they figured that was enough - I don't know - I just took the approval and ran. Best wishes - it'll happen!

Hi Valerie,

I also have BCBSMN.  You can go to their website, www.bcbs.com, and see if there is anything there.  When I went through this (about a year ago) I had to only do 3 months of supervised diet (meet with doctor & dietitian once a month), had to see a psych (minimum of 2 visits, I actually saw him 4 times), do the MMPI.  I wasn't required to write a letter, but I journaled LOTS of things and sent that in along with my approval.  I journaled not only what I ate, but my feelings, experiences, fears, realizations, discoveries, etc.  They said that really helped them to see how my mind set changed over those 3 months and made them realize that I was a good candidate for this process.  Good luck to you - it will happen, just have faith, and patience!

I went to BCBSMN website and got the exact policy for you. I used this as my bible. I used this as my check list on what I needed. Hope this helps.  Rose Medical and Behavioral Health Policy Manual Section: Surgery Policy: IV-19 SURGERY FOR MORBID OBESITY

Description:	Morbid obesity is associated with a reduction in life expectancy and significant co-morbid medical conditions. Surgical intervention is considered a form of risk reduction in morbidly obese patients with serious medical problems, although there is no long-term data to support survival benefit. The decision to undergo surgical intervention is shared by the physician and patient and is based on factors such as the patient’s present weight, weight loss history, physical and mental readiness, patient expectations and motivation, all of which are determined by a qualified team of professionals with integrated knowledge of medicine, surgery, psychiatry, nutrition and exercise.
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Policy:	The surgical treatment of morbid obesity is ACCEPTED MEDICAL PRACTICE for patients who meet the following criteria: 1. The patient must have a Body Mass Index (BMI) of ³40. Patients with a BMI of 35-40 will be considered when there is documentation of a co-morbid condition, such as hypertension refractory to standard drug regimens, cardiovascular disease, degenerative joint disease, documented obstructive sleep apnea, severe persistent asthma, or diabetes (See attached Body Mass Index [BMI] table at the end of this policy. This table was adapted from the NIH "Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults"). 2. The condition of morbid obesity must be of at least two years duration. Because attempts to lose weight over this two-year time period may cause the patient’s BMI to fluctuate around the required levels, the two-year time period will not necessarily start over, or be prolonged, but will be reviewed on a case-by-case basis. 3. The patient has participated in at least one medically-supervised attempt to lose weight within the past two years. The medically supervised weight loss attempt(s) must have been at least six (6) months in duration and must be under the direction of a medical doctor (MD or DO), physician’s assistant (PA), nurse practitioner (NP), clinical nurse specialist (CNS) or a registered dietitian supervised by an MD, DO, PA, NP, or CNS. The patient’s participation in a structured weight loss program must be documented in the medical record by an attending physician who supervised the patient’s progress. A physician’s notation, alone, is not sufficient documentation. Documentation should include medical records of the patient’s progress throughout the course of the weight loss program. 4. The patient must be evaluated preoperatively by an eligible licensed mental health provider (i.e., licensed psychologist [Ph.D or M.A], licensed clinical social worker [LICSW], or licensed marriage and family therapist [LMFT]) to ensure the patient’s ability to understand, tolerate and comply with all phases of care and to ensure a commitment to long-term follow-up requirements. The evaluation must also ensure that any psychiatric, chemical dependency, or eating disorder contraindications to the surgery have been ruled out. Documentation of this evaluation must be included in the prior authorization. 5. The physician requesting authorization for the surgery must confirm that the the patient’s treatment plan includes pre- and post-operative dietary evaluations* * Pre- and post-operative dietary evaluations are defined as evaluations conducted by a dietitian/nutritionist.
	Surgical Procedures The following surgical procedures are considered ACCEPTED MEDICAL PRACTICE in the treatment of morbid obesity when the previous criteria have been met: · Open gastric bypass using a Roux-en-Y anastomosis or vertical banded gastroplasty; · Laparoscopic gastric bypass using a Roux-en-Y anastomosis. · Gastric banding, consisting of an external band placed around the stomach (i.e., Lap-Band® and REALIZE Band). The following surgical procedures are considered INVESTIGATIVE as a treatment of morbid obesity: · Laparoscopic vertical banded gastroplasty; and · Gastric bypass using a Billroth II type of anastomosis, known as the mini-gastric bypass; and · Biliopancreatic bypass (i.e., the Scopinaro procedure), biliopancreatic bypass with duodenal switch (see Coverage section below); · Open or laparoscopic sleeve gastrectomy, either as the sole procedure or as the first stage in a two-staged procedure (See Coverage section below); · Balloon procedures; and · Sclerosing endotherapy of the stoma for weight regain following previous weight loss surgery Re-operation Criteria: Subsequent surgery for morbid obesity is subject to the previous criteria and the patient’s contract benefits. Panniculectomy following surgery for morbid obesity is considered COSMETIC, except when both of the following conditions are met: · documented chronic, recurrent infection and · documented interference with hygiene and activities of daily living (ADLs).
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Coverage:	Prior authorization is recommended for all bariatric surgery and revisions/reoperations and for panniculectomy. Submitted documentation should address the patient selection criteria described above. Coverage for the following procedures may be considered on a case-by-case basis for patients with a BMI > 50 and significant co-morbidities: Biliopancreatic diversion with duodenal switch Sleeve gastrectomy.