Insurance questions

My husband will be signing up for insurance at his job, this month. I know wls is covered with his insurance. I have researched Anthem's medical policy and this is the requirements that I must do before they will approve it. See below, I highlighted the non-medical weight reduction in red. What kind of non-medical weight reduction are they asking for and for how long? They don't specify for how long you are suppose to do a diet, and this I need to know.  As anyone ever dealth with Anthem's Blue Cross? I'm on my second month of supervised diet with my physican and will be seeing a nutrition counslor next Monday that my Dr recommended. Am I on the right track for this? I want to have all my ducks in a row so that I can get my approval with no problems.

1. BMI of 40 or greater, or BMI of 35 or greater with an obesity-related co-morbid condition including, but not limited to:
   • diabetes mellitus; or
   • cardiovascular disease; or
   • hypertension; or
   • life threatening cardio-pulmonary problems, (for example, severe obstructive sleep apnea, Pickwickian syndrome, obesity related cardiomyopathy); AND
2. The individual must have actively participated in non-surgical methods of weight reduction; these efforts must be fully appraised by the physician requesting authorization for surgery; AND
3. The physician requesting authorization for the surgery must confirm the following:
   • The individual's psychiatric profile is such that the candidate is able to understand, tolerate and comply with all phases of care and is committed to long-term follow-up requirements; and
   • The candidate's post-operative expectations have been addressed; and
   • The individual has undergone a preoperative medical consultation and is felt to be an acceptable surgical candidate; and
   • The individual has undergone a preoperative mental health assessment and is felt to be an acceptable candidate; and
   • The individual has received a thorough explanation of the risks, benefits, and uncertainties of the procedure; and
   • The candidate's treatment plan includes pre- and post-operative dietary evaluations and nutritional counseling; and
   • The candidate's treatment plan includes counseling regarding exercise, psychological issues and the availability of supportive resources when needed.

I have Anthem Blue Cross/Blue Shield and I did not have to do a six-month supervised diet.

The non-surgical methods of weight reduction requirement was satisfied by showing them my logs from my weigh-ins at Weigh****chers. My logs were from 1-2 years before I even thought about WLS.

Not sure if my policy is exactly the same as your policy, but the requirements looks similar to what I had to do.

I have Anthem and they paid for my DS Surgery 10 months ago. Last June I got insurance for the first time in years and the first day insured I had my consoltation.  My Anthem plan required a 6 month supervised weight loss and meeting with a nutritionist and a psychologist. Make sure there are no more than 31 days between you visits to your doctor for your supervised weight loss. I had 5 months but not 6 before I had my insurance and they made me start over. Also 15 years ago I had the same insurance and lost 125lbs in the 6 months and lowered my BMI to much and didnt qualify for the surgery. I wish now I had those 15 years back, healthy. In the past 10 months I have lost 201lbs and fill great I am 20lbs away from my goal weight and have not started working out yet. My insurance also pays for skin removal so I plan on taking full advantage of that. I am glad I had the DS and would recommend it over any other procedure. Just jump through the hoops that your insurance provider makes you and it should work out. I would choose a Dr. who knows how to deal with the insurance companies too. Good Luck!