BC/BS AZ (PPO)

Hi AZ members, I have BC/BS AZ and I have a problem. Here it is:

BC/BS of AZ:  Current history and physical, psychological evaluation, nutritional consultation with licensed nutritionist, 5 years medical records, letter of recommendation from PCP, and continuous participation in a weight loss program for 6 months or longer within the past 12 months.   Weight loss program includes:

·        A structured program that includes documentation of diet and dates of participation (a minimum of one face to face visit per week attendance for dietary counseling/education is required.   And

·        A structured exercise program (unless medically contraindicated) designed and supervised by a certified or qualified professional with documentation of attendance (a minimum of three sessions per week of participation in an exercise program is required) and,

·        Demonstration of a commitment to results by documenting weight loss, maintenance, or no more than a 5 pound weight gain over a minimum six month period.  I have everything except for the exercise program. Do Ihave a chance of getting this approved? Has anyone ever got approved with some of these requirements? I guess I am holding on to a little faith that I have left...at this point I have given up and just have to realize that I will be obese for the rest of my life.  

Why would you give up?  YOu are 99% done!  You've done the really hard stuff. ......."IF" a doc were to write a note that you were unableto do the exercise because of your co-moribds or weight then that should suffice. If not....the worst that could happen is that it's 6 months from now......... Tackle that last hoop with a vengeance!  You can do it!

I know....it just seems like when I get close to this happening, something always seems to get in the way.  I am worried that they may not accept my physician supervised visits as a nutritional visit and that my weight loss program from Weigh****chers (2004) is not considereed within 6 months. It is always something else that blocks my chances of getting this done.  Maybe Ican get my doctor to write a letter.  JRAZ, Thank you for your input. :)

My experience is that medical insurance plans take what is written literally.  If you plan well you could be done and ready for approval in six months.  Some of the programs (i.e Scottsdale Bariatric Center) have doctors on staff to fulfill the six month diet requirement and know what it takes to get approved.  I met someone in the waiting room there who had BC/BS AZ (PPO) and she was seeing Dr Emershad (Scottsdale Bariatric) for the diet program and going to curves and having them sign here log to prove that she was there.   Give the letter a try if you wish, but if it doesn't work don't give up just get organized! Steve 

Thank you Stephen, I will definitely get on it. I am suppose to be meeting with an consultant at True Results to get some help. I was hoping that my 6months program with Weigh****chers would help me....but that happen in 2004.  A coordinator made a suggestion for me to talk to my doctor to find out first if it is medically ok for me to do 3x a week at a gym and if not a letter may be helpful. If all fails I may give SBC a call and go ahead and fill out the forms from the website. thank you so much, Stephen