Hi - Newbie with BCBS MI
Hi Everyone,
I am Nichole and I am ready to start my WLS journey! This website has already helped quite a bit. But of course like all newbies I have questions. I received my insurance criteria sheet with the following that needs to be done: But seriously is this it and then “magically" I am approved? So what's the catch?
The Patient has a body mass index greater than 40 or greater than 35 with co-morbid conditions. (Check)
The patient is between 18-60 years old. (Check)
A physician has documented failed medical management including a structured professionally or physician-supervised weight-loss program for a minimum of 6 consecutive months within the last 4 years.
(Started 02/12/09) Surgeon Consultation is scheduled for 04/14/09 I am hoping that my Weigh Watchers receipts will suffice the 6 month professionally monitored diet.
There is documentation that the primary care physician and the patient have a good understanding of the risks involved and reasonable expectations that the patient will be compliant with all post-surgical requirements. (I am pretty sure I will be a good girl)
A contracted mental health professional has preformed a psychological evaluation to establish the patient emotional stability and ability to comply with post-surgical limitations. (Scheduled for 02/23/09).
I am Nichole and I am ready to start my WLS journey! This website has already helped quite a bit. But of course like all newbies I have questions. I received my insurance criteria sheet with the following that needs to be done: But seriously is this it and then “magically" I am approved? So what's the catch?
The Patient has a body mass index greater than 40 or greater than 35 with co-morbid conditions. (Check)
The patient is between 18-60 years old. (Check)
A physician has documented failed medical management including a structured professionally or physician-supervised weight-loss program for a minimum of 6 consecutive months within the last 4 years.
(Started 02/12/09) Surgeon Consultation is scheduled for 04/14/09 I am hoping that my Weigh Watchers receipts will suffice the 6 month professionally monitored diet.
There is documentation that the primary care physician and the patient have a good understanding of the risks involved and reasonable expectations that the patient will be compliant with all post-surgical requirements. (I am pretty sure I will be a good girl)
A contracted mental health professional has preformed a psychological evaluation to establish the patient emotional stability and ability to comply with post-surgical limitations. (Scheduled for 02/23/09).
Nichole
05/29/09 Open RNY Surgery!!! On My WLS Journey!!
Currently --115lbs as of 11/18/2009!!
05/29/09 Open RNY Surgery!!! On My WLS Journey!! Currently --115lbs as of 11/18/2009!!
Hi Nicole.
Congratulations on making he decisions to start this journey! One thing, most insurances do not recognize WW as a physician supervised 6 month diet program. I had more than 8 months worth of WW logs, but initially was denied. You have to have 6 months of weighing in with your physician, with documentation in his/her notes that you are there for 'weight loss' . If you started that on 2/12/09, you 6 months would be up in August. Make sure to have an appt each month.
Nan
HW 300 / SW 280 / CW 138 / GW 140
Hit Goal 4/2/2010
You know what I have BCBSM/PPO and I was magically approved... I didn't show any reciepts for WW. My PCP just wrote a letter (I wrote she signed) that she has been seeing me for the past whatever years and that I have been trying to lose weight on my own. They actually do not have a preapproval/preauthorization process. As long as you meet all the criteria you ARE approved or covered for surgery. It was actually too good to be true when the Dr office told me that....but now I'm upset that I chose the wrong surgey. Oh well hope all works out for you.
Highest weight- 262lbs
Lap band- Aug 2006 - 254lbs.
Lowest w/band 214lbs. .
Gained up to 271 due to the band
Got DS revision April 2010!! Current 145lbs
At 5'8 my goal was 160lbs but I surpassed that with the DS!!!!!!
Lap band- Aug 2006 - 254lbs.
Lowest w/band 214lbs. .
Gained up to 271 due to the band
Got DS revision April 2010!! Current 145lbs
At 5'8 my goal was 160lbs but I surpassed that with the DS!!!!!!
I'm sorry I don't have the letter that I wrote. I am very unorganized and of course figured I wouldn't need it again anyways. I'll try to remember what it said.
To whom it may concern,
Ms. Jane Doe has been under my care for the last several years or 6 months. She has tried several diets under my supervision and has not yeilded any significant weightloss if any. She has a bmi of 40/35 with (insert cormorbids here) in which her weight has a great effect on. We have discussed the option of (whatever surgery wanted) and I believe that she would be a good candidate for this surgery. We have discuss the risks as well as the benefits of this surgery.
You can add or take away this is just me going off the top of my head...HTHs.
To whom it may concern,
Ms. Jane Doe has been under my care for the last several years or 6 months. She has tried several diets under my supervision and has not yeilded any significant weightloss if any. She has a bmi of 40/35 with (insert cormorbids here) in which her weight has a great effect on. We have discussed the option of (whatever surgery wanted) and I believe that she would be a good candidate for this surgery. We have discuss the risks as well as the benefits of this surgery.
You can add or take away this is just me going off the top of my head...HTHs.
Highest weight- 262lbs
Lap band- Aug 2006 - 254lbs.
Lowest w/band 214lbs. .
Gained up to 271 due to the band
Got DS revision April 2010!! Current 145lbs
At 5'8 my goal was 160lbs but I surpassed that with the DS!!!!!!
Lap band- Aug 2006 - 254lbs.
Lowest w/band 214lbs. .
Gained up to 271 due to the band
Got DS revision April 2010!! Current 145lbs
At 5'8 my goal was 160lbs but I surpassed that with the DS!!!!!!
R. c
on 2/24/09 10:19 pm - nashville, TN
on 2/24/09 10:19 pm - nashville, TN
Since your policy says "professionally or physician-supervised weight-loss program", there is a good chance that the WW records will suffice. Let us know how it goes. :)
~* Rosie *~ 2-16-10
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