BC/BS PPO HELP

I have BC/BS PPO thru Comcast. I see my doctor the 5th of Sept any advice? To make this paper nightmare so smooth? Thanks

I have BCBS PPO and my benefit pays 100% if I qualify.   The list of requirements I was given directly from insurance:

BMI 40+ with 5 years of weight history
Preop eval  letter
6 month monitored diet must check in with dr. each month weight/etc…
6 month documented medical history
Diets I’ve tried
Original photos
Two letters of recommendation :  Pcp letter    Surgeon letter
List of health conditions (co-morbidity)
Description of surgery, diagnosis and procedure codes to be used
How the surgery will affect my lifestyle and how the weight effects you know

 

I have a BCBS PPO (Horizon Direct Access BCBS NJ), and my requirements are:
*6 months diet (used to be only with registered dietician or physician, but just changed their manual this month to include programs like WW and Jenny Craig)
*BMI 40+ or 35+ with comorbitiy
*at least 18 years of age
*psych eval
*enrollment in a program run by physician or dietician for pre- and post-op nutritional, behavioral, and social support and guidance

Up until just this month, they also required 5 years of weight/BMI history. This is no longer required. Also up until this month, they would not cover WLS for people with BMI 60+ (said it was "investigational"). They just removed that restriction as well.

Jillybean,

How did you find this out?  I have the same insurance and wasn't aware of the changes. 

I've been doing my supervised diet for 6 weeks and when my surgeon's office called BCBS to confirm benefits they were told I didn't have to do the supervised diet.  Well, I don't believe it but am definitely going to call BC/BS and ask about the changes. 

I've been racing around town trying to make sure I had the 5 years of complete medical records.  This change sounds fantastic to me!!

What are you doing for your supervised diet?

Sharon

I see my regular physician once a month for my 6 months diet. I have type 2 diabetes, so I am counting calories and carbs and adding walking for exercise. It's stuff I was already doing anyway, but now I check in with my doc monthly. She asked me if I wanted a diet pill, but my blood pressure goes up and down a lot, so I certainly don't need anything to make it increase even more!

Jill,

Thanks again for the insurance info.  I printed all 12 sheets of the manual regarding the updates.  I will definitely qualify under the new requirements.    I'm so glad to know someone else with the same insurance.  

Good luck with your journey!

Sharon

I have BC/BS of MN.  I had my first visit with my surgeon today.  While there they gave me a list of things my doctor has to list when I visit for my 6 mo of med supervised visits.  WELL I've been going to him for this since 1/08 and I missed Mar, April, and June.  SO July started over for me.  If so by Dec I should be approved.  However my doc has not documented the following on my chart:
Lifestyle Modifications/ Diet Education Discussed
Exercise/Increased Activity Education Discussed
List any Behavioral/Diet Goals for this patient

I do have records with my:
Height, Weight, BP, Pulse, Temp and I have hypertension.
In the summer I saw a nutritionist he referred me to. 

Have you had any luck with your insurance?  Please, Message me and let me know if you have!  I'm so worried I'll be denied!!!  You also want to make sure you have all of the correct documention done by your PCP. 
Thanks
Kim