BC/BS MN I need advice!!

I had recently given up on my dream of WLS after realizing the struggle I will have with insurance.  But...I then found out my co-pay (out of pocket) is down to $300.   My insurance needs documentation of a medically supervised diet....that is where my problem lies, I have been sent to a dietician for my diabetes a couple times over the years, but my Dr.s always have been more concerned with sending me to a psychologist for my depression, than having me do a medically supervised diet.  Has anyone had experience with BC/BS MN and will the dietician appointments count?? I really could not afford the surgery with out the low co-pay, since my doc needs payment up-front, before surgery.   Also I am starting to have alot of swelling of my feet & hands, has anyone had a Dr. write a letter to ins, and had the insurance co, approve surgery without the guidelines met?  As in a special case?? I want this surgery so bad, and I feel like the fight is going to be to much for me to handle right now. Deb

Deb, I understand your frustration.  I have BCBS in IN and I am currently completing the requirements for the surgery.  I personally have never heard of BCBS approving a surgery without the requirements, however the medically supervised diet does not have to be surpervised by a nutritionist/dietician.  My doctor is "supervising" mine and BCBS is fine with that--actually I think most people have their doctor supervise the diet.  I have seen a nutritionist once--but that was related to my newly diagnosed diabetes.  If I were you, I would start seeing my doctor monthly for this.  The sooner you start, the sooner you will meet the requirements. Good Luck!

I know this isn't what you want to hear- but I tried to get approved with just some visits to the doctor over the last year and BCBS of AZ wouldn't accept that as enough. I have to do the 6 month diet. I know it seems like forever- but hey- I have been fat for 6 years- whats another 6 months? I am more worried about their other crazy stuff like proof of a BMI of over 40 for the last 5 years. Well, I don't necessarily have proof of it- though I am sure I was at least at 40. 

You should know- no insurance company will approve you nor will any doctor allow you to get the surgery without a psych eval. If your dr is really worried about your depression you should try to get it under control right now- otherwise you might have a hard time later getting approval. Just an extra though to add to your worried I know- but it's always better to know in advance right? One last thing- and your insurance is a bit different than mine- but even though my copay is only $300 there was a letter sent out last year stating that there is now a $1000 access fee for bariatric surgery. YOu might want to see if that applies to you as well so you can budget yourself accordingly and save as necessary. This fight is worth your life Deb. Never forget that. You have to keep fighting. Insurance companies want you to give up because then they don't have to pay. In the end- they win because you didn't stick to it. Find a buddy- find someone that will keep encouraging you- I know how hard it is- trust me. I am on month 4 of 6 and everyday I get so discouraged but then I have my wonderful boyfriend just encouraging me to keep it up. If you ever feel yourself getting lost or down- email me. I will keep you going!  YOU CAN GET THIS!!!!

I too have BC/BS of MN.  The diet has to be medically supervised for at least 6 months with a lot of documentation from your PCP.  Their notation alone will not cut it.  You also have to have BMI over 40 for at least 2 years or 35 with co-morbidities.  I recommend contacting the insurance company to see what kind of documentation you need and schedule an appoitment with your PCP immediately.  When you call BC/BS see if you can talk to a rep named Deb.  She helped me out a lot.  She had WLS a year ago so is very emphatic to us.  She will let you know exactly what you need for your particular policy.  Also, remember you might also have co-insurance too.  Like mine is 15% after deductible with a max out of pocket $1500/year.  Deb will also let you know this.  good luck

Thanks for your advice, I just finished talking to the insurance co., the person I talked to had no knowledge of a "Deb" but was helpful.  I now understand what they are looking for, and I feel better about it. I also learned that I need to send my records to my surgeon, not directly to the insurance co.  Good thing I found that out when I did. The BMI and psych eval are done and  sent to the ins co all they need is the diet stuff. Also my co-insurance (out of pocket) is just under $300.00, right now.  After my heart tests it should be at zero, man I need this surgery to be approved now, I'm not sure I could afford it otherwise.  Thanks to everyone *****plied, and if anyone alse has anything to add, please do!!

Hugs, Deb

I was just reading the qualifications from BCBS of MN (since they are my insurance carrier): "The patient has participated in at least one medically-supervised attempt to lose weight within the past two years. The medically supervised weight loss attempt(s) must have been at least six (6) months in duration and must be under the direction of a medical doctor (MD or DO), physician’s assistant (PA), nurse practitioner (NP), clinical nurse specialist (CNS) or a registered dietitian supervised by an MD, DO, PA, NP, or CNS. The patient’s participation in a structured weight loss program must be documented in the medical record by an attending physician who supervised the patient’s progress. A physician’s notation, alone, is not sufficient documentation. Documentation should include medical records of the patient’s progress throughout the course of the weight loss program." Considering that I have a lengthy history of failed "diets" and a well-documented weight loss program that I participated in from 2002 - 2005, I am a little miffed as to why I would need to again attempt (and fail) yet another diet. Has anyone heard of BCBS MN accepting a diet that is not within the two-year period?