Are My EYES deceiving me??? (BCBSTX policy) ...also applies to IL, NM, OK, and Federal

Okay,
so I am at the end of my six month weight management program. And I decided to reread my policy. The policy was updated 7/1/2009.
What first stood out was the fact that the 5 year history of a high BMI was no longer on there.
But then I went back and read it again and it appears that the six month requirement has been dropped to three months.
Can anyone browse over this and tell me if I'm right? i don't know if i should be happy or excited or upset that i've been waiitng six months which seemed long to me but then again if the policy was updated just this July I would have still been going through it!!!!


http://medicalpolicy.hcsc.net/medicalpolicy/home?corpEntCd=TX1&corpEntCd=IL1&ctype=POLICY&cat=Surgery&path=/templatedata/medpolicies/POLICY/data/SURGERY/SUR716.003_2009-07-01#hlink

Here's an excerpt from the policy as well:

  An appropriate candidate will have evidence that *comprehensive non-surgical treatment has been attempted prior to surgical treatment of morbid obesity

*Comprehensive non-surgical treatment of morbid obesity appropriateness criteria:

• Documentation of active participation in a comprehensive, non-surgical program of weight reduction for at least three (3) months, occurring within the twenty-four (24) months prior to the proposed surgery.  (NOTE: The initial BMI at the beginning of a weight reduction program will be used to meet the BMI criteria for the definition of morbid obesity used in this policy.)
• A program will be considered appropriate if it includes ALL of the following components:
  1. Nutritional therapy, which may include medical nutrition therapy such as a very low calorie diet such as MediFast and OptiFast or a recognized commercial diet-based weight loss program such as Weigh****chers, Jenny Craig, etc.
  2. Behavior modification or behavioral health interventions.
  3. Counseling and instruction on exercise and increased physical activity.
  4. Ongoing support for lifestyle changes to make and maintain appropriate choices that will reduce health risk factors and improve overall health.

Most BCBS plans dropped the 5 year history requirement last July.    I have BCBS of NJ and they still require the 6 month supervised diet.  

The way your policy reads does look like you only have to complete 3 consecutive months.

I have BCBS TX....and these are the requirements they gave me.  I just participated in a weight loss challenge at our local YMCA and I have had them write a letter that I particpated.  The program included organized excersise classes, nutritional classes, and recorded weekly weigh ins....I am hoping this is acceptable for the "3 month non surgical program of weight reduction.  What do you think?

You are correct in how you've read the policy change but you haven't wasted time or anything like that.  The policy didn't go into effect until 07/01/09 so you still had to abide by the "old rules".  The only way to have shortened your diet program would be if you had completed say only 3 months by the 07/01/09 policy change date.  You would then qualify by the new policy criteria.  Make sense?

If it makes you feel any better, I have BCBS of Illinois and the 5-year weight history was still required under my PPO plan as of Feb 2009 (when I submitted for approval).  I had to go thru a 6-mo weight loss program as well.  I had to fight to get my surgery; two denials, two appeals.  It was horrendously stressful.  And get this:  the 2nd denial was for an incomplete 5 yr weight history!  I was lucky in that I remembered one emergency visit and that's the only thing that got me over that argument.  I really would have been ticked if I hadn't remembered it & been able to get that record (which had been sent to storage no less), and BCBS denied me again and then have a policy change only 5 months later.  Just know you haven't gone thru your program for nothing.  You learned skills you need to be a success with your surgery for the long term.  Best of luck to you!