BCBS Criteria question

Hi All;   I'm in an unusual situation but I think some of you have experience in some of this...I did have a band in 2005, but it was removed...turns out I have Barrett's,  and my EGD last week showed a big change- it went from being seen only on the microscope to being super evident, and erosions in my stomach.    I also have a valve that isn't closing, even when the Doc tried to get it to close.  He said that I am definately having surgery- just waiting for the final biopsies to see what exactly is growing in my stomach and on the esophagus.  I had asked him about WLS, and he thinks it's a really good idea, in fact, he said that we could probably do the repair and WLS at the same time.  I was hoping for Gastric Sleeve, but I think with my situation I'll have to do whatever the Doc thinks is best.  Now, if there are cancer cells there, I won't have to worry about weight loss surgery, because THAT surgery will be so drastic I won't ever worry about eating again!  :/

Okay, so here's my question:  I went online to my BCBS site, and they do cover surgery, I fit all the BMI, GERD, Sleep Apnea, , but this one is kind of vague:
"Clinical documentation reflects attempts to lose weight by non-operative means, including self-directed dieting, nutritional counseling or commercial or hiopital-based weight loss programs within the past two years"

From everything I've read here, people had to show 6 months of consecutive visits for weight loss...this statment just says I have to have tried it within the last two years.  What do you think? 

I think it means you have to show documented failed weight loss atempt in the last two years,not necessarily a 6 month dr supervised weight loss program although the way i am reading it that would also work,
Good luck,
H

I have BCBS of TN. They require a 6 month consecutive diet. I have been told it has to be in the last 2 years. I had a 9 month diet that was documented in 2006. But that was not good enough. I had to do another 6 month diet any way. I also have to lose 10% of my highest weight. You may want to call the insurance comp. and see what they say. Also check with your WLS doctor's office. They may be able to help also.

Maddy

I have BCBS as well. I will think if you had the band before and it was removed due to health reasons along with other health records to include the recommendation of doc for the wls to occur. They MAY have somewhere no one can see it..in fine prints that you can omit the six month consecutive supervised diet.  I am currently completing my six month supervised diet which was required before they approve me.

Many have also been apporved for revisions with BCBS. I will call them and ask them detail questions to see what they say.

Thanks all.  I'm seeing the doc tomorrow, and will have a better handle on what I need to deal with.  I don't think my other problem can wait 6 months, so we will just see.

I have BCBS of New Jersey and that same statement is in my manual.  I had to do 6 consecutive months of monitored diet with a physician, nutritionist or other supervised plan like weigh****chers, etc... 

Good Luck!