I LOVE BCBSAL!!

I am about to fax the approval letter to the hospital so they can give me a date! She said I will have one next week!!  AAAHHHH!!!

My insurance is about to switch over to bcbsal. What were their requirements. Rite now I'm with United healthcare and they have me doing the 6 months supervised diet. Did you have to do the diet part?

heck yes I had to do that stupid diet! And they don't play about it either. Total it ended up being 7 months cuz they dont count the 1st visit as the first month. My diet was from Aug-Feb. It sucked having to wait all that time, but honestly it gave me time to look and ask questions about this surgery. I was able to prepare myself for it. They ask for...

6 month diet
3 year proof of obesity (I used dated pics for 2007)
BMI over 40 I believe
At least one co-morbidity
no smoking for at least 3 weeks

I really can't remember all of them so I will copy and paste exactly what it was....

1. BMI of 40 or greater, or BMI of 35 or greater with one or more of the following co-morbid conditions: HTN on optimal drug therapy, atherosclerotic cardiovascular disease, diabetes (must be treated with insulin or oral agents), pulmonary hypertension, or severe obstructive sleep apnea. (RDI of 50 or greater). (NIH, 1998 and American Society for Bariatric Surgery). For BMI calculation see http://www.cdc.gov/nccdphp/dnpa/bmi/calc-bmi.htm. 2. The condition of morbid obesity (BMI

≥ 40 or BMI ≥ 35 with presence of comorbid conditions) must be of at least 3 years duration. There must be documentation in medical records by a primary care or attending physician of patient height and weight for the past 3 years. A letter from the primary care physician and dated photographs will be considered in lieu of recorded heights and weights. Random reviews of these patients’ charts for accuracy of stated information will be conducted. 3. Documentation must be present of participation in medically supervised weight loss program. For purposes of coverage, we (BCBS) recognize medical supervision of the diet and activity program by practicing MD's who are not bariatric surgeons, such as family practitioners, internists, and other primary care specialties. Documentation provided by these health care providers will be recognized in the review process. At least one attempt must occur during the one year prior to request for surgery or date of surgery. Documentation must support participation in the program for six consecutive months. The following criteria must be met for this participation:

▪

Documentation of participation in a physician supervised program of nutrition and increased physical activity (including dietitian consultation, low calorie diet, increased physical activity and behavioral modification). Documentation of program participation must appear in the medical record by the attending Proprietary Information of Blue Cross and Blue Shield of Alabama 4

physician. Documentation should include comments by the physician regarding patient progress or lack of progress. A letter does not meet this requirement. There must be medical records to document medically supervised weight loss attempts;

OR



 

4. A complete history and physical must be performed by the bariatric surgeon to include height and weight.

5. The patient must be at least 18 years of age. 6. Due to the surgical morbidity associated with concomitant pulmonary disease coverage will not be provided for anyone who has smoked in less than eight weeks prior to surgery.

Hope that helped...lots of people say that they had issues with bcbsal, but as long as you have exactly everything they are looking for they are the easiest folks to deal with! Good luck!

Acceptable with medical record documentation of medical supervision are: Weigh****chers, LA Weight Loss, Jenny Craig, EatRight etc. Not acceptable are self-directed programs such as joining a gym, Atkins’ diet, calorie counting, low fat, cutting back, internet programs, etc.

Hi Channel --

I also have BCBS AL and I just got denied for RNY.  They said that my 6month medically supervised diet didn't meet their requirements.  I've been seeing a registered dietician for 6 consecutive months where they weigh me each month and we go over goals, etc.  I'm so disgusted.  I'm waiting for the denial letter to come in the mail so that we can appeal this decision.  I've spent almost 8 months preparing for this surgery...which was supposed to be tomorrow!

sorry about the font on the last part....I have no idea what happened there...here is the website...

https://www.bcbsal.org/providers/policies/final/053.pdf

Thank you, Thank you, Thank you!! You have helped me so much.