6 month diet question?

missjewell
on 5/1/09 9:01 am - WA
So I was I was going over my records and for the last two years or so I have been to the Dr. pretty much one-two times a month for various issues and every time we discuss my weight, my diet plan and my work out program and she documented it all.

She also gave me a 5 year copy of all my weights.

I have also met with a nutriounist twice in the 1.5 years who also gave me copies of her findings and documentation of the counseling she gave me for diet and excercise.

Shouldn't that all be good enough for insurance (Highmark BCBS PPO)???
Purple_Sparkles
on 5/1/09 9:55 am
Goodness I would think so…at least you can always submit your items make sure your doctor notes that you discussed WL, Diet, Behavior during your PCP visits and then submit. All they can say is “No-Try again…" Good Luck! I had BCBSofMI PPO; so they are a little different.
Nichole05/29/09 Open RNY Surgery!!! On My WLS Journey!! 
Currently --115lbs as of 11/18/2009!!
Hislady
on 5/1/09 2:56 pm - Vancouver, WA
Maybe but just depends on your policy. Some BCBS policies will OK with no problem. However on mine I had to see the doc once a month for 6 months for weight loss only and couldn't have gone in for any other problem.  Also as for the 5 year weight loss mine had to be not just a list of weights but the doctors chart notes. So here's hoping it'll work but don't be dissapointed if you have to send more detailed info. Best of luck to you!
J-Mac
on 5/2/09 6:09 pm - Burlington, WA
Hey there!

I work for Regence BS here in WA and my best suggestion for you is to call your insurance and ask them for the webpage or have them fax a copy of the medical policy for meeting the criteria (if in fact surgery for obesity is covered under your plan). That way it is clear to you and/or your doctor what you need to submit to have the surgery approved.

You can always request that information in writing...

Hope this helps you!
juicyprincess
on 5/3/09 5:20 am - Tacoma, WA

you must go to your plans website and find their policy, if you cant find it, call and have them take you to it. print this and read it carefully. i did this and am so glad i did.
BCBS site said only 6 months of pcp/dietician consecutive visits but it was actually 12 months (even dr srikanth office thought it was 6). So every single calendar month i had to go to both, i also had to have the 5 yr wt history showing a certain bmi or higher.

After completing all of those things i received 4 rejections before i finanally demanded my approval. i demanded a supervisor and an explanation as to why i was being rejected whne i had policy "xyz..." and it clearly spelled out the inclusion/exlcusion criteria which i also fit perfectly...1 day later i got approval. I found with my bcbs plan i would call every other day to follow up, an if on the day i called there was no new info, i called the next day. i took detailed notes of the date, time and operators name and what our conversation said (using quotes where possible) and if there was follow up involved, i always asked for that persons extension so i could follow up if they didnt call me back...I took 4 weeks but i did it and am having surgery on the 13th.
good luck to you...PS u might also want to start picking a surgeon because they required a whole lot of preop testing before you ahve surgery and it takes a bit of time to get it all done!
Also, find a local support group to attend!
best of luck

 

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