Capital Blue Cross approval

Hello - I'm new to the OH forums but have lurked off and on for a year.

Last December I had a consult with Dr. Pupkova at Barix. She said I was a good candidate for RNY surgery (100 lbs. to lose, BMI is about 42).

Capital Blue Cross came back and said I needed a 6 month documentation of medically supervised wt loss program.

So - I played by the book and enrolled at a hospital based program. 10 sessions with a dietitcian, 3 dr. visits in that time.

But Barix says that Capital wants not just a letter from my dr. saying that I did this - they want detailed notes. I'm not sure that detailed notes exist from the hospital program, but I have outlined everything we covered in the program, and asked my dr. to include this in his letter.

I have thought of adding other documentation such as sample food logs, sample feedback from the dietician, etc.

Did anyone else have difficulty with an approval from Capital BC? Part of the issue is that at my husband's company they had 3 people have surgery within a fairly short time at a "mill" type place - young girls, no follow ups, etc. Their HR person talked to BC and asked for more stringent screening....and I'm the one caught in the web.

As you know, it's very hard to get to the point of mentally accepting that I am REALLY ready for this. To be caught suspended between "yes I can" and "no you're not approved" is stressful and NOT fun.

However, if I had to, I'd go back to the dietician and go for another 6 months, being sure that detailed notes WERE kept, while seeing my dr. monthly as well. It' shard to imagine, though, being another 6 months out with no real progress or certainty.

Any pointers are very welcome!
Lynn in Lancaster County

Lynn - I would imagine that your Dr and dietician should have documentation of your visits - ask them to write up a summary including as many details as they can - the more the better in this case! And lets hope thats enough -  I have my fingers and toes crossed for you!

Liz

PS - welcome to the greatest group of people ever!

What Liz said!

I had to do a 12 month Dr supervised diet history.  It had to be 12 consecutive months and the Dr had to put down my weight & BMI.  Plus, she had to put what diet I was following (SmartStart cereal for b-fast, WW meal for lunch and a sensible dinner), what exercises I was doing (walking, elliptical), how I felt about my progress so far (upset, because the weight just wasn't coming off...a couple of lbs here, a few there) and what I would do between this visit and next!  Some people go to the Dr the same day each month.  I couldn't do that, so I just made my appts anywhere from 4-5 weeks apart.  As long as it was once a month and it wasn't the last week of month one and the first week of month two...then week 3 month three.  Space them out normal, but make sure it is once a month!!!

Hi and welcome to the boards.

I have BCBS.  I also had to do the six month diet.  My surgeon has a NUT that works with him.  I would go to their office once a month and get weighed, have my BP done and then the NUT would look over my menu for the month.  She would make suggestions about what I was eating and in some cases..not eating. 

Before I knew it the six months were over and I was on my way for approval. 

They sent all of my paperwork in and two days later I got a call from the surgeons office telling me that I was approved!!

Very quick and easy.  I hope this helps you.  I was asked by several people if I minded the six month diet plan.  I really didn't mind doing it and I would do that and a lot more.  I traded in a dulldrum life and now I am loving my life.  Just jump threw the hoops...sometimes it feels like it will never end but it's so worth it!!

Best Wishes,

Chrissy