fed blue cross blue shield

 FEP 2011 Definition of Morbid Obesity:
A condition in which an individual has a Body Mass Index (BMI) of 40 or more, or an individual with a BMI of 35 or more with co-morbidities who has failed conservative treatment; eligible members must be age 18 or over.

Benefits for the surgical treatment of morbid obesity, performed on an inpatient or outpatient basis, are subject to the following pre-surgical requirements.
The following requirements apply to gastric restrictive procedures, gastric malabsorptive procedures, and combination restrictive and malabsorptive procedures to treat morbid obesity:

• Diagnosis of morbid obesity for a period of 2 years prior to surgery.
• Participation in a medically supervised weight loss program, including nutritional counseling, for at least 3 months prior to the date of surgery.
• Pre-operative nutritional assessment and nutritional counseling about pre- and post-operative nutrition, eating, and exercise.
• Evidence that attempts at weight loss in the 1 year period prior to surgery have been ineffective.
• Psychological assessment of the member's ability to understand and adhere to the pre- and post-operative program, performed by a psychiatrist, clinical psychologist, psychiatric social worker, or psychiatric nurse.
• Patient has not smoked in the 6 months prior to surgery.
• Patient has not been treated for substance abuse for 1 year prior to surgery.

I am currently  starting the process for wls.. this is fed bcbs required goals. My BMI is 53,
my only concern is:the evidance of weight loss in the year prior being ineffective part... I have dieted and tried  but on my own.. I keep meeting that brick wall..lol... So how do I prove it if I have been doing it on my own?

I do My consult with surgeon this week...Have started my 3 month with my pcp.... )

Gracee
Good luck. I also have BCBS fep and trying to get approve. I think the new requirements this year is stupid.  Hope everything goes well for you!