BCBS NJ

Has anyone been approved in the last 6 months with BCBS NJ?  I'm looking for the new guidelines, whether there is a supervised diet still in the policy.  If you have been, how long did it take?  What kind of documentation do I need for non-surgical weight loss programs...  Thanks for the help!

You can actually find the guidelines on your BCBSNJ website. just click on Providers and search for obesity surgery. I have copied some of what I found on their policy. You would always do best to call your insurance and ask. get them to send/email the info .
https://services3.horizon-bcbsnj.com/hcm/MedPol2.nsf


II. If it is NOT specifically excluded by the member's contract, surgery for morbid obesity (bariatric surgery) is considered medically necessary when all of the following lettered criteria are met:

D. Within the 12 months prior to the time of surgery, the member must meet all of the following requirements:

1. Documentation of previous participation in conservative (non-surgical) weight loss program or diet program/plan (e.g., Weigh****cher, Jenny Craig).

[INFORMATIONAL NOTE: Programs supervised by a registered dietitian may not be a covered service under a member's contract.]

2. Documentation of participation in an organized multidisciplinary surgical preparatory regimen in order to improve surgical outcomes, reduce the potential for surgical complications, and establish the member's ability to comply with post-operative medical care and dietary restrictions. The regimen should provide guidance on diet, physical activity, and behavioral and social support prior to and after the surgery.

3. Documentation of pre-operative psychological evaluation provided by a licensed mental health care professional familiar with the implications of weight reduction surgery. (Please note that psychological testing is NOT included in this requirement.)

Within the 12 months prior to the time of surgery, the member must meet all of the following requirements:

1. Documentation of previous participation in conservative (non-surgical) weight loss program or diet program/plan (e.g., Weigh****cher, Jenny Craig).

This is the only part that trips me up.  I called the insurance company (for whatever that was worth) and all she would do to me is read the policy.  The same one I've read a million times!!  "All I can tell you is what the poicy says"....  Yep, heard that a dozen times. :)  Well, my information will be sent in hopefully this week. After that, i just wait.