6 months medically supervised weight loss

I switched insurance in July with a new job and now have BCBS.
BCBS requires 6 months of medically supervised weight loss.  I have gone to my GP in August and September, but I put it off and now can't get in until the first week of November.   I know I probably put out my surgery another month, but will the insurance company make me start all over?

Anybody else run across this same situation?

Haven't had that situation.  From what I understand (and could be wrong) is that as long as you have documation that you have been on a supervised diet that is what you need. If not documented then I believe you will have to start from step one.  To double check I would call BCBS and your WLS clinic!
Best to you on the first steps in your journey

ps...here's hoping that one of the peeps here that know the insurance stuff can give you more concrete answers!

I have heard that if you do not see your doc EVERY month, they will make you start over.  BEG to get into the doctor.  I would hate to see you have to start over.

I talked to BCBS about this very issue, because their policy doesn't specifically say you have to be seen every month for 6 consequtive months.  I doesn't even say you have to be seen 6 times.

It says "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."

When I talked to BCBS CS they said I could just be seen at the beginning middle and end. 

I shared this info with Park Nic and they gave me a doubting look and said they would hate to have my surgery denied because I didn't document this monthly.  Gee, I would hate that too.  I tend to be a PITA about these kinds of things - the devil is in the details, I say.  So I kind of beat this whole thing to death.  THe ins specialist said that I had talked to CS and they don't actually make decisions, so their interpretation may be off.

I am with the PP - BEG BEG BEG to be seen.  Is it a practice in which you could be seen by a PA or CNP this month?  It doesn't have to be the same practitioner every month.  I saw my PA in Sept and Oct and am transferring over to PNC for the last 6 months.

good luck.

I have BCBS and just finished my 6 month supervised attempt. My months were consecutive and the WLS clinic was adament that I was seen 1 time per month. I chose to see them for it because they know what it takes documentation wise to get approved. (I don't know what the criteria is but I felt better working with them since they've "supervised" many people before) I read the BCBS statement as "a 6 month attempt." That to me says a SINGLE attempt that is 6 months long. I could be wrong, call them. In the meantime, I'd get on the cancellation list to bee seen, or could you make "sick" and get in that way? You would be weighed, not sure what else your doctor has been documenting as part of your attempt. Are you doing food logs? Maybe even if you don't see YOUR doctor, you could bring them along and ask whoever you see to put them in your file just incase BCBS does mean 6 months in a row. I really think that's what they mean, because doing it in a row shows a concerted effort on your part. I'd be interested to know what you find out.

 Howdy, Howdy....

I am so glad to hear that I am not the only one that is confused about this BCBS process --- I initially started this process about Aug 2005 --- time does fly -- and I 'dropped' the ball more then a couple times.

Anyway...I am dealing with Ginger at St. Paul Surgeons and she won't send anything to insurance for me until I have 6 months of consecutive documented by my doctor weight for me. I could choose to join WW, but don't want to waste the money. I WOULD go every month if I were you.

This is what I did --- (and this is probably way more information than you need, but here goes) I made an appt w/my primary doc in August (she happens to be an OBGYN), and I have re-occurring skin tags and she zaps them off with liquid nitrogen. So I got weighed in August. In September, I went back (only because I wanted to be weighed again) and some of these skin tags were being stubborn and I had to have some burned off. And this week I took my 2 boys in for flu shots, and just asked if a nurse was available to take my weight and document it, but they were crazy busy. I am going to call ahead of time (suggestion from the clinic) tommorrow or Friday so I can get a documentation for the month of October. Then in November I have a mammogram scheduled so I'll get weighed in for that month. And then December and January I'll either make something up -- or just call the cllinic and go in when a nurse is available. And that will be my 6 months !!! I am going to follow up with my clinic next month to make sure my doctor is putting notes in there as well.

That is just my '2 cents' for what it is worth. Good Luck and keep me posted.

Julie H.
Pre-Op
West St. Paul

 

 

I have BCBS of MN and I had to do the 6 months medically supervised diet also and for my the 6 months DID NOT have to be consecutive months. I actually counted the day I asked my doctor about WLS and who she would reccommend as my first month, that was in June. I then went July, Sept, Nov, and Jan. I have to say though, I talked my insurance about it and they were fine with that as stated above as long as I had documentation that I went to the doctor. My issue wasn't so much with the insurance, but with the nurse at the doctors office. I switched surgeons during the process and the nurse at the new clinic was trying to tell me that I had to start over from the time I was first seen there. NOPE!!! I did not have to do that at all. I was able to use all of my old medical records from the previous months. I would for sure check with the insurance company and follow their policy.

~Rose