Does anyone know how they are? I was assigned a nurse through them. We have already spoken. I was told i do NOT have to do a consecutive 6 months of supervised diet as long as i have had 6 visits within the last 2 years and i have. I've been following my physician and nutritionist for well over a year now and had that faxed to her. She said she approval process is relatively easy. My bmi is current 52 and i have ashtma, feet problems, sleep apnea, pre-diabetes, back pain, problems with absesses boils yuck due to rubbing skin, etc. She said i met all the criteria. My program requires sleep studies which i had already and at least 2 months of cpap therapy which i have also already completed. The process for my surgeons office is 4-6 months and my new deductible doesn't start until April 2013 =) i found this out yesterday. Also i have $5500 oop so far and UHC told me under my ppo plan once i hit the $7500 max oop they will cover 100% which means i won't have to pay my co-insurance granted surgery is before April 2013. At this rate with all i have done already as part of the requirements i may just make it.

And my center is a center of excellence as well as the surgeons and my company doesn't exclude WLS so how quickly do you all think i would be looking at for an approval? My bmi has been over 50 now for over 5 years and my sleep apnea was just diagnosed in July. I also had my gallbladder out last May,

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. 

Does anyone know their requierements for surgery approval??

Hello,

I have Aetna PPO and myself and all three of my kids were approved for surgery.  Yes, there are hoops to go through but not much different than any other insurance.  If you go to Aetna.com and in their search engine type in 0157 it will bring up their clinical bulletin of the reqirements needed to qualify for bariatric surgery. 

Basically, you need to do a 6 month physician supervised diet or a 3 month multidisciplinary program (one or the other).  Three of us did the 3 mo MD program and my one sone did the 6 month plan.  YOu have to prove being morbidly obese for the past 2 years (meaning a BMI of .40 with no co-morbidies, or a BMI of >35 with at least 2 documented co-morbidies)

If you meet the requirements and are going to pursue, let me know and i can send you some stuff on how to go about doint the 3 month program as I have shared it with others on this site.  Like I said, myself and all three of my kids have had surgery.  Two of us were denied at first and I needed to appeal, but won the appeal so I have a lot of experience and knowledge of what type of documentation is needed for approval by Aetna.

Hope this helps.

Nan

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!