6 month supervised program

I have BCBS of AZ. They require the 6 month physician supervised nutrition program before they will even think about approving me for the surgery. Of course they don't cover a visit to the nutritionist, I have to pay for that out of my own pocket. I'm going to go ahead and make the appointment anyhow because I want to make sure I cover all my bases, but I was wondering what everyone else did if your insurance required such a thing? Did you also get proof that you went to the gym three times a week, etc? What else can I do?

I have BCBS of NY... I think all of Blue Cross Blue Shield requires the 6 months of doctor supervised weight loss. I went to my PCP and got the documentation done. I was not required to go to a nutrionist. I would check with your case manager with the insurance company and see if it is actually required to see a nutrionist. I personally think it would be better to see a board certified physician. No... I didnt need gym documentation, everything I was doing my doctor put in her medical notes, walking so many times a week, stationary bike, attending curves, etc. Good Luck! ~Nicole

LOL! I should have just read further ahead! Nicole said the same thing......

Keri, Are you sure you need to see a nutritionist as well? Who is your surgeon? Often the program itself (surgeon's program) will offer their nutritionist to aid in insurance authorization without extra charge. ..... I know that patients I have worked with under BCBS have just had to go to their primary care docs for 6 consecutive monthly weigh-ins. The docs should make detailed chart notes in regard to not only the weight aspect but also the recommended (and reported) exercise, your frame of mind, etc. Those doctor's notes will then be faxed to your insurance; along with all other requirements at the end of the 6 months. BCBS should pick up the expense you have with your doc. Good luck! It's definitely a journey worth fighting for! Joyce

I have BCBS of AZ Federal. I had gone to a "diet" doctor in town on and off for many years. I didn't have documentation that I went consistently every 2 weeks or every month--If I lost any weight I would go--If I didn't I wouldn't go. It was the same doctor in all those years and they had sent all my records to Dr. Blackstone's office. BCBS did pay for the inital visit that would have been over $300 and I just had to pay for the copay. I also had to pay the $325 up front for the psychologist but BCBS also paid for that. I am still trying to get my money refunded (since Nov 1, 2006) I spoke to the billing person and she just keeps telling me that she will "check it out" I even faxed her my copy of the invoice that BCBS had sent me. I will just keep calling her. I had belonged to Curves for almost 2 1/2 years and only went about 5 times. I sent them my inital paperwork when I signed up but not how often I went. Just write down EVERYTHING that you ever tried--it's sort of depressing to think how much money is spent on trying to lose weight but it just builds your case. Good luck!

Hi Keri, I have BCBS of Empire (New York) I too had to do the 6-month dreaded diet documentation. I went to my regular dr. and got weighed in every month. Dr. Fang's office gave me a little form for the doctor to sign every month with the date and the weight to be written in by the doc himself...so in the end I had my 6 slips of paper to send with the rest of my stuff to the insurance company. It was kinda humiliating especially since I gained 6 pounds on my 6-month diet. I was required to go to a nutritionist too. It was just one visit and I went there to talk about my type 2 diabetes, that way it was covered by insurance. I hope that this helps alittle. Insurance requirements seem to change at the drop of a hat. Good luck on your journey! Hugs, Ginger

My son has BCBS of MN and the ladies at Dr. Juarez's office were just sure that insurance would not cover the surgery withouth the doctor supervised diet requirement. My son and I had been going to weigh****chers for about 3 years. He did lose about 130 pounds but gained it back. He has wanted to have surgery for about the past 2 years and I just could not support it. He finally reached a point where he could handle it himself financially and was going to go through with it with my support or without, and as quickly as possible. I decided to support the effort and insisted that we submit to insurance regardless of what anyone thought. I bombed them with 3 years of weigh****cher cards and a letter of recommendation from our PC. Much to our surprise, they covered the surgery! It may have to do with his size (just over 500) and the documentation from WW showing that he really can do it. We were thrilled. Good luck to you!

It is interesting that so many of you with BC BS had to have the six month documentation. I have BS of CA and I did not have to have it. Their only requirement was verification from my primary care doctor that I needed the surgery. It was Dr. Juarez' office *****quired the pulmonary and cardiac clearance prior to surgery, not the insurance company. I do believe that some of the requirements the insurance companies require are set up when they negociate their contracts with the different companies, so even though two people may have BCBS of AZ if they work for different companies the insurance might require different things. I have heard of some of them having an exclusion in their policies for WLS. Just be sure you get all ducks in a row before starting something. Gina