BC/BS of Iowa

Do you truly have to have 2 years of failed documented weight loss with a doctor?  My BMI is over 50 and it has been for at leasty 3 years.  But I have no health issues.

Do some research on your the BCBS of Iowa website (because they update the requirements from time to time.   My BCBS of NJ recently updated their policies for Surgery for Morbid Obesity and it's not longer required. 

Do you have a current policy manual?

unfortunately our current certificate requires 3 years of documented failed doctor monitored weight loss .. you know that when you are in this boat you avoid the doctor, I only go annually for the girlie stuff.  I am very unhappy.

I'm assuming you have Wellmark? Here is what their medical policy manual says on their website (just updated in June 2008):

Criteria for Coverage:

• Patient is at least 18 years old

And

• The patient must have documentation in the medical record of failure to sustain weight loss within the two years preceding surgery and documentation of the health care provider’s monitoring of the patient’s progress toward a goal of weight loss.  

And

• The patient must be a motivated individual with acceptable operative risk and must be evaluated by a licensed mental health provider to determine the patient's willingness to comply with pre and postoperative treatment plans, and a strategy to ensure cooperation with follow-up must be documented.

All that really says is that you have to show failure to sustain weight loss within 2 years (which will be evidenced by your annual weights from you gyn) and that a medical provider needs to have been aware you were trying to lose weight. It does NOT say you have to have been dieting for 2 years. I would CALL them and ask exactly what documentation is necessary to meet this requirement--it may be as little as only 3 months of weight loss attempts within the past 2 years.

Thanks for the insight.  Since I work for the state our Wellmark plan is a bit different than you see on the websight, but I am going to check out the wording more closely tomorrow to see if it has the same tone as what you are putting to this one.  I am hoping that our certificate is being changed too but won't know until November.  I am going to one of those informational meetings the surgeons put on later this month. 

well this is what our plan currently says

You have a documented history of failure to sustain weight loss with medically supervised dietary and conservative treatment for at least three years, including within two years before surgery.

That just says failure to sustainweight loss for at least 3 years. I still don't see anything that says you have to have been actively DOING a medically supervised diet for 2 years. Again, CALL them and ask what the specific documentation requirements are.