6 month diet for BCBS

steph86001
on 9/10/16 7:41 am

Can anyone give me any insight on this 6 month medically supervised diet required by BCBS? Currently my BMI is 42....if I lose weight on this diet and fall below 40, could they deny my surgery? I don't have any obesity-related medical issues such as high blood pressure, diabetes, etc. which BCBS allows you to have a BMI of 35 and be approved for surgery. 

Liz WantsHealthForAll
on 9/10/16 8:30 am - Cape Cod, MA
VSG on 03/28/16

Most insurance companies use starting BMI.  I have United Healthcare and they also require the 6 month supervised weight loss.  My BMI dropped below 35 but they still paid because I qualified at the BMI I started at.

Liz 5'3" HW: 219 SW: 185 GW: 125 LW: 113 Desired maintenance range: 120-125 CW: 121

White Dove
on 9/10/16 8:44 am - Warren, OH

I was very careful not to let my BMI get out of the accepted range during the six month pre-op diet. 

Why take a chance on being denied, when we all know that the pre-op weight will be quickly regained if there is no surgery?

Insurance companies are staffed by human beings.  Some will be compassionate, others will try to save the company money by denying you coverage because you demonstrated that you no longer need surgery,

Real life begins where your comfort zone ends

Liz WantsHealthForAll
on 9/10/16 10:23 am - Cape Cod, MA
VSG on 03/28/16

White Dove has a good point.  My surgeon's office didn't "officially" record my last weight (where I went under) because of the risk even though UHC said that it was the starting one that counted - that last weighing was done after approval and just before surgery, so I was 35 or higher for all recorded weights including those submitted for approval. I was lucky that all went through ok.

Liz 5'3" HW: 219 SW: 185 GW: 125 LW: 113 Desired maintenance range: 120-125 CW: 121

denise0530
on 9/14/16 2:20 am - PA
RNY on 05/16/12

I have Fed BC/BS and was required to do the same 4 years ago.  They do it partially to know that you are committed to the process and lets be realistic you probably aren't going to lose that much in 6 months, because if you could have done it that way you already would have!!  Is part of the game we have to play...

Denise Marie SW 248 CW 156 Roux-en-Y 5/16/12                        

        

steph86001
on 9/16/16 7:45 am

Good point...thank you! 

brneyezz45
on 10/15/16 12:07 am
Revision on 10/18/16

I have BC/BS and did not have to do 6 months.  It all depends on the plan.

cinand
on 10/15/16 2:34 am - Houston, TX

I couldn't go below a 40. That's what I was at the end of my 3 months diet. My nut told me not to worry. I could weigh with jeans, shoes and a jacket if I needed to. 

Srhultberg
on 10/15/16 5:23 am
VSG on 10/05/16

I had to do 3 months for Cigna. My doctor's weight loss program was, "Eat better, exercise more, and don't lose any weight." In other words, don't change anything. Lol. He thinks the whole game is stupid and a waste of time. My weight did fluctuate during the 3 months, so it kind of showed the insurance company that I was trying, but it wasn't working. Good luck! I think you'll be fine! 

Cosmos2112
on 10/15/16 6:22 am

I'm in the same boat. My BMI is just over 35. I have two more NUT and doctor visits. I have Medical Mutual. I have diabetes, sleep apnea among other things. I'm eating three healthy meals a day. I can't lose more than 2 pounds. 

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