Recent Posts

noftessa0401
on 11/26/13 5:03 am - San Diego, CA
RNY on 12/27/12
Topic: RE: On a 3 month (4 visits) Nutrition, Exercise & Therapy Program for BCBS Federal

I can only reply regarding the dietician visits - I didn't have a revision, and I don't have BCBS Federal (I have Aetna).  But, I was told that I had to do a 3-month multi-disciplinary supervised diet/exercise regimen.  It was crucial that it was at least 90-days.  If it was 89-days, the surgery request was denied. 

From what I understand, if you need 3-months of dietician visits, that means you need 4 dietician visits.  For example, the first visit on 8/12, the second visit no earlier than 9/12, the third visit no earlier than 30 days past the previous visit (approx. 10/12), and the last visit no earlier than 30 days past the previous visit (approx. 11/12).  This would give you 3 months of documented dietician visits.  I am pretty sure all insurances look at these visits this way.

Good luck!

HW: 274 | SW: 232 | CW: 137 | Goal: 145 (ticker includes a 42 pound loss pre-op) | Height: 5'4"

M1: -24 (205) | M2: -14 (191) | M3: -11 (180) | M4: -7 (173) | M5: -7 (166) | M6: -8 (158) | M7: -11 (147) | M8: -2 (145) | M9: -3 (142) | M10: -2 (140) | M11: -4 (136) | M12: -2 (134) | M13: -0 (134) | M14: -3 (131) | M15: +4 (135) | M16: +2 (137)

Virgie Tschirhart
on 11/26/13 2:10 am, edited 9/9/14 12:41 pm - Midwest City, OK
RNY on 12/27/17
Topic: On a 3 month (4 visits) Nutrition, Exercise & Therapy Program for BCBS Federal

My doctor's office called me last week and said that BCBS Federal called her and said, I did not have the required Nut 3 month visit reports.  She told me that I had make 2 more appointments with the Nut so I did.  I saw her on the 22 November and my next appointment with her is on 11 Dec.  I also received a letter from BCBS Federal yesterday saying that my predetermination was denied, because of not providing 3 month Nut appointment reports.  In addition, it was also noted that I was not in compliance with my 2 previous weight loss surgeries as far as dieting and exercising.  BCBS Federal on approved the LB back in 2008.  I did self pay on the Sleeve in 2009.    I called the doctor's office and she said when BCBS Federal called her they said they would be sending out a letter saying it was denied but she said they would accept the next 2 reports from the Nut when I complete them on 11 Dec 13.  She said don't throw in the towel yet! 

Has anyone else had a similar case like mine?   Thanks.

 

 

 

Update: I decided to go with Dr. Lana Nelson in Norman, OK.  If I could have started all over again, I would have gone with the RNY, instead of the LB back in 2008 and then revised to the Sleeve 2009.  Dr. Lana wants to repair my hiatal hernia once and for all and at the same time revise the sleeve to the RNY.  I am doing so well right now on the 3 month program that BCBS Federal requires.   These are my appointment dates, I hope they are according to their requirements:

1st Visit on 08-25-14

2nd Visit on 09-29-14

3rd Visit on 10-27-14

4th Visit on 11-24-14

 

  

Virgie Tschirhart

Lap Band - 2008, Sleeve - 2009, RYN - 2017

Started Program Weight July 13, 2017 - 194.2

Before Surgery Weight December 27, 2017 - 185.0

Current Weight - February 2018 - 161.0

Aquafinaflo
on 11/24/13 12:27 am
VSG on 02/18/14
Topic: RE: Has anyone written their own letter?

i know that it's been some time since someone has posted here. but this is what i am going threw now. could someone pm me a sample of their letter.

Mary Gee
on 11/23/13 5:52 pm - AZ
VSG on 05/14/14
Topic: RE: Since my insurance wont cover for another weight loss surgery, can I switch insurance

Are you insured through your employer or self-pay?  Don't know what your options are based on info given.  But if you change insurance, there may be a waiting period for pre-existing condition.  Insurance is very tricky these days.

Why isn't the band working?  Are you compliant with your eating regime, or have you "fallen off the wagon"?  I'm sure any insurer would want the reason for removing band and having another wls -- it must be medically necessary, and you haven't said why "the band isn't working".

Mary

 

Haynesmomma2
on 11/22/13 11:43 am
Topic: Ins Question

Hey! I have been looking in to the sleeve procedure for a while now, and have even done the paper work with the bariatric hospital.. But recently my husbands job has decided to switch insurances from UMR to Blue Cross Blue Shield of KY.. But that plan doesnt come into effect until the new year, so my process has kinda been put on hold, which is super frustrating. I am dying (like..literally..lol) to get this done. I have ballooned up to 355 in the last year after having back to back pregnancies and I am really, really feeling the weight.  I was just wondering if anyone has had any experience with BCBS of KY or with Dr. John Oldham or Dr Derek Weiss..  On UMR there was a 6 mo dr. supervised diet required..Here is what BCBS requires, but I'm not sure on how they want the non-surgical method of weight loss documented. I was a member of WW for nearly a year, but that was almost 4 years ago.. I know you can't rush these things, but I am SO ready to be healthy for my kids.. they are really being cheated out of a mom..

 

 

  1. BMI of 40 or greater, or BMI of 35 or greater with an obesity-related co-morbid condition including, but not limited to:
    • diabetes mellitus; or
    • cardiovascular disease; or
    • hypertension; or
    • life threatening cardio-pulmonary problems, (for example, severe obstructive sleep apnea, Pickwickian syndrome, obesity related cardiomyopathy); AND
  2. The individual must have actively participated in non-surgical methods of weight reduction; these efforts must be fully appraised by the physician requesting authorization for surgery; AND
  3. The physician requesting authorization for the surgery must confirm the following:
    • The individual's psychiatric profile is such that the candidate is able to understand, tolerate and comply with all phases of care and is committed to long-term follow-up requirements; and
    • The candidate's post-operative expectations have been addressed; and
    • The individual has undergone a preoperative medical consultation and is felt to be an acceptable surgical candidate; and
    • The individual has undergone a preoperative mental health assessment and is felt to be an acceptable candidate; and
    • The individual has received a thorough explanation of the risks, benefits, and uncertainties of the procedure; and
    • The candidate's treatment plan includes pre- and post-operative dietary evaluations and nutritional counseling; and
    • The candidate's treatment plan includes counseling regarding exercise, psychological issues and the availability of supportive resources when needed.

I know I qualify with the BMI and I understand all the requirements under the third section.. Just wondering if anyone has had BCBS and done diet portion under the second section... Thanks!!

Tammy C.
on 11/20/13 8:57 am
Topic: Bariatric Surgery Is Not a Covered Benefit For Colorado

by Matthew Metz, MD, FACS

Last month I attended my local Medical Society’s meeting in Denver.  The title of the meeting was, “The New Insurance Exchange—What Physicians Need to Know.”   Representatives from Connect for Health Colorado, the CO Division of Insurance, and Denver Public Health were on the panel to help explain how the insurance coverage under the Affordable Health Care Act will work, and how it will affect physician practices and health plan contracts.

During the Q&A session I relayed a question from one of my patients to the panel: “Which plan on the exchange covers bariatric surgery?”  According to one of the panel members, “This is not a platinum insurance program.  If someone wants that kind of plan, they can purchase it outside the exchange.”  Click here to read the full article and to comment!

All my best, 

Tammy Colter
Director of Media & PR
Editor-In-Chief
ObesityHelp.com
OH Magazine
schmidtavon
on 11/19/13 12:12 am
VSG on 02/10/14 with
Topic: BCBS Of Michigan
Does anyone have any experience with BCBS of Michigan paying for land band to sleeve revision?


Robin Schmidt

   

                                                                    
Virgie Tschirhart
on 11/18/13 8:41 pm - Midwest City, OK
RNY on 12/27/17
Topic: Waiting for BCBS Federal of Oklahoma

I was just wondering how long did it take you all to get your answer from BCBS Federal?  This is a revision. 

I just hate to wait, but who doesn't?  

Thanks.

Virgie Tschirhart

Lap Band - 2008, Sleeve - 2009, RYN - 2017

Started Program Weight July 13, 2017 - 194.2

Before Surgery Weight December 27, 2017 - 185.0

Current Weight - February 2018 - 161.0

Missusnutini
on 11/14/13 3:44 am
Topic: RE: Healthy Indiana Plan

I just got off the phone with Deaconess Weight Loss Solution and YES they do accept HIP insurance. But it has to be through Anthem. So if you're applying for HIP like I am remember to check the Anthem Blue Cross Blue Shield box. 

HappyAddy
on 11/13/13 2:09 pm
VSG on 12/17/13
Topic: EBMS

Hi There-

Has anyone dealt with EBMS insurance and what were your results?  I have dual coverage but I was told that I must submit to then\m before I can submit to Blue Cross/Blue Shield Federal.  I am so scared of being denied.

Please help....

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