HELP!! 12 mo. Consect. Supervised Attemps

I am very intersted in getting lap-band surgery. I already went to an informational seminar and am scheduled for my medical evaluation. I have have verified with my insurancane company (BCBSM Community Blue PPO) that the surgery is covered and no pre-auth is required. However, they indicated that I need 12 consecutive months of physician or professional supervised attempts to lose weight. Problem is, I don't have it. I have been over weight my entire life (30 years) and within the last 7 years it has increase to morbidly obese (BMI 40) I have enrolled in The Medical Weight Loss Clinic 2x during this time as well as had physician prescribed weight loss pills such as Merdia and Phentermine. But it has not been "physican or professional supervised" for 12 consecutive month, although I did continue with them for over 12 mo, just not supervise. (became to expensive). Anyway has anyone been approved by bcbsm without having this documentation?(consecutive 12 mo supervised) An insight will help. Thanks Brown Eyes

This is probably the LAST thing you want to hear, but everything I've been told is that the insurance companies are REALLY strict about pre-op requirements. I mean, if they have a way of getting out of paying, they'll use it. At least that's what the insurance expert told us at the wls seminar I attended. And she's been dealing with insurance comapanies for years on trying to get people approved. She said that there are a lot of companies that require 1 year's MD supervised diet, and that many patients have tried different ways of getting out of it (like using LA weightloss or Weigh****chers), but it doesn't work. The insurance companies demand documentation from an MD or they won't pay. There's always the option of paying for it yourself, but if you need to use insurance, you should start the 1-year thing as soon as possible. I'm really sorry! I have to do a 3-month thing and I thought THAT was bad. I just wish that they would take my word for it that I've tried every diet out there--and there isn't anything that an MD can tell me that will suddenly work magic! Anyway, good luck!

Thanks for the info! I explained my situation to one of the ladies in the sugeons office. She informed me that we would have to gather all of the records I have from the Weight Loss Clinic and other physicians (criteria states physician or professional supervised so the Clinic would be okay) as well as the records I documented when I was following the same diets on my own and send it to BCBSM for approval. She said I would also need to send in all medical doc. to support the "medical need" for sugery. Along with letters from the surgeon, my PCP and myself detailing the need for surgery. I forgot to ask if they had every had to try and get approval this way and if it worked!! I guess we'll see! Thanks again, Brown Eyes

That's really good news! I don't see why the clinic wouldn't count as professional supervision--and it sound like that's acceptable for your insurance, so I think it's gonna be smooth sailin' for you!

I have BCBS of ILL PPO and they denied me even with 18 months of medically supervised because they said my doctor's notes were not "detailed" enough. I gave up after two and a half years of trying to jump through all their hoops. I'm going to pay for it myself. Good luck!

Thanks for the information. I had my first medical evaluation today. The internist thinks I am a good candidate and wants me to move forward with the additional exams. She said that she will work with the surgeons and my PCP to try and get me approved. However, worse case scenario, I will have surgery May 2007. Thanks again!! Brown Eyes

Hey Brown Eyes, I FINALLY got approved after almost a year of going back and forth with my Insurance ****igna PPO) I was required to do 6 months of a "Supervised Physican Weight Loss Program" Even though I had been on Jenny Craig for over 6 months, Weigh****chers and every other diet there is they kept denying my surgery. I was so stressed out I thought I would have to pay for the surgery myself! They did pay for my referral to a Nutritionist, but it was a nightmare dealing with the continued rejection. I was told to appeal. Bottom line is the insurance co.'s don't want to pay and they think if they discourage you with denials you will just go away! I'm soooo glad I didn't!! I was told that so many people are turned down and you have to hang in there because I was not alone!!! Get an atty and appeal. Sounds like you need this surgery just like I do. My BMI is 40 and I had to have a stress test 2 weeks ago for my heart. I have gained 8 lbs in the last 6 months and I have trouble exercising because of knee pain! I wish you the best! If you have any ?"s feel free to email me! AJ

Thanks for the response AJ. Since my orginal post, I met with my internist for my medical evaluation. I was told I am a good candidate and to proceed with all of the pre-op testing. I also had my stress test today. The internist said she has seen people with the same insurance I have get approved with out the 12 mo. supervised diet. They had like 4 months, so we'll see. Worse case scenario is that I have to wait 12 mo. Thanks again for the info and congratulations on your approval!!! Brown Eyes

Do the 12 month supervised diet as the insurance companies won't approve you. They are strict now. When I first started my diet it was only 6 months and then it changed and I was never informed until I sent in my paper work to get approved and I had to go through another 6 months. It's well worth it if you want WLS. Best of luck Donna