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Hi there. No, I was not required to do the 6 month supervised program. In fact, I was given the impression that my approval would be quick and easy. The requirements were just PCP approval, a statement from the surgeon that my past attempts at weight loss were sufficient, and the psych eval. I had everything completed early and stayed on top of having the psych eval sent to the surgeon's office. My paperwork was submitted 4+ weeks ago and the insurance company is still refusing to acknowledge receipt when I contact them. However, the insurance coordinator at the surgeon's office contacted them and they said it was received and being reviewed.
HW: 387 (12/13) ConsultW: 383 (12/13) SW: 321 (4/9/14) CW: 234.6 (10/19/14)
Hi, I also have Highmark and if I were you I would request a copy of your bariatric portion on your policy. Specifically the weight loss section. You may even be able to view it online. I think the website is www.highmarkbcbs.com
I know it's a pain! I couldn't tell by reading your post if you needed to complete the 6 month required diet/exercise program as a requirement from your ins. I have to complete a monthly visit to both my PCP and NUT, plus all of the other things you mentioned, psych eval, etc. My surgeon's office said that after all of that had been completed after the six months, then that would submit all my paperwork to the insurance company for approval. Just wondering, did they require the six months?
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I have BC/BS and I felt that way also when I first visited my PCP. My surgeon's office provided me with a form that my PCP would complete on each visit. I think they took the one from Cigna as a matter of fact and retyped it for general use for all patients to have. Now, for me, I had to work with the surgeon's nutritionist and my PCP both. My PCP's notes were very vague-kind of like what you had stated....three meals a day, exercise three times a week, etc. He never wrote anything down specifically, like eat 1,500 calories a day, etc. I am pretty sure the nutritionists notes were more in depth. My PCP did write down any changes I would have personally within the last month in my notes. For example, I pulled a muscle in my back and he would write-exercise limited to a total of 4 times a month due to back injury, etc. Hope this helps!
I have BC/BS. I completed 3 months of the required 6 month diet/exercise program that was supervised by my PCP and NUT TWO YEARS ago for ins. purposes. My insurance rep. that works with the surgeon's office said that she wants to send in everything I have now, (including all med. records and previous attempts for weight loss from 2 yrs ago), to just see if my ins. will approve my surgery.
Does anyone think this is a bad idea? I have since developed sleep apnea, my BMI is around 44 and I have pre-diabetes. I don't want to blow my chances for approval. Does anyone think this will? Just trying to get people's thoughts on it. I am wondering if I should just do the six months all over to not blow my chances, but I don't know if her sending in everything will do that either. Any thoughts anyone?
Hmmm, that is so weird. Do you have BC/BS? I can view my policy online. Can you do that? I wonder if you contacted your HR Dept. at work if they can send you the full written portion of your policy, (just the weight loss portion)? Let me know if you find something out, can you? I am very confused on who to believe. Since my posting I have contacted the insurance rep. that works for the surgeon so she can check. Sometimes they know how to word things to your insurance company. That may be a good idea too.
I'm in the same boat. My insurance said (the rep I spoke to) did not see a mention of six months. It angers me because I'm a revision and if I don't need to wait I won't. I too asked them for written section regarding bariactrics and they sent me some handbook with no info! Frustrating.
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The conference for this year will be held in Los Angeles, California on August 15-16, 2014.
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I am just getting started in my journey to hopefully have WLS this year. I contacted my insurance and asked them for a copy of the bariatric portion of my policy, specifically the weight loss surgery section of it. They sent me a copy and it did say that I needed to complete 6 consecutive months of supervised weight loss program that needs to be done through my PCP and a Nutritionist. I called them once also and asked them what I needed to do for approval and they said basically the same thing. My surgeon's office called today and told me that they spoke to my insurance company and they were told that I didn't need to do the 6 months before applying for surgery. Does anyone have any suggestions on what I should do? I am so confused now.
I have Cigna and they require 3 months of PCP supervised diet and next week I am going for my first month weight in (one month down and two more to go), but I am thinking I am 2 pounds more than when I started. I think it is because I am getting on my period and because I have been very constipated in the past couple of weeks, but who knows and the insurance doesn't care anyway. But my question is about what kind of diet did your PCP put you on? Was there a diet? What did he/she tell you about changing of habits? I was expecting she would talk about nutrition or give me some sort of guidance but all she said was to eat 3 times a day, exercise at least 30 mins 3 times a week, and to carry small snacks with me since I am always on the go and I don't end up eating out or late.
What was your experience with your PCP in your first appointment? Because I felt like a deer in a headlight- no guidance, no direction, no nothing.
Hockeymom87 · 0 replies · 652 views
