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If they can't Tell you exactly where to find it ,I would demand that I. Be approved right that. Minute. .
If it is a surgeon requirement that is a different matter. It has to. Be in clear understandable writing in your policy or they can't insist on it.
Some insurance companies allow WW, but I don't beleive myfitnesspal will work. They will also take a certified nutrionist or your family doctor if you see they once a month for six months.
UHC states
Patient must be enrolled in and have participated in an organized weight loss program for a period of at least six months prior to surgery. The weight loss program does not have to be physician directed. Does myfitnesspal.com count? Or does it have to be like WW, TOPS, etc? Anybody know?I still don't have my approval and it was submitted on the 14th. I have been calling either every other day or every day. They told me that they have 15 days after they receive ALL of the information they need. Since my surgeon's nurse faxed over additional info on the 21st but they didn't upload it to my file until Thursday, the 24th, my 15 days starts over on the 24th.
I went through this process 2 years ago and needed an additional 5 months of documented weight (but put it off due to my divorce). They sent me a rejection within 7 days that time so I'm trying to be positive that the longer weight means a better chance of an approval since they didn't deny it outright.
I found out that the surgeon's nurse did not send my 2012 stuff over and I'm nervous because my bmi was 39.7. The nurse told me when she finally sent it in last Monday that she would write a bmi of 40 since it rounds up to that but Aetna is very picky and I know that some people have been rejected for a bmi of 39.9. I also wrote a letter letting them know that I was going through a divorce during that time and was skipping meals due to stress. I was also on a diet but my weight spiked again as soon as I stopped skipping meals. Hopefuly that will help.
Keep calling and asking. Good luck - let me know how things turn out.
ABath-just checking in with you to see if you heard anything yet? I am getting kinda of nervous the longer they make me wait.
Your six month requirement must be with an MD. My pcp did not do this but my surgeon did so that worked out. Also you can find physicians who do weight loss programs and stick with that for 6 months. My bc/bs is with PA. The insurance will go by your first weigh in with the doctor. So just be aware what the insurance requires your bmi to be at to qualify.
So after meeting with my surgeon yesterday and finding out that I am pre-diabetic, have high cholesterol, some degree of fatty liver disease, and my thyroid levels are off (I have had hypothyroidism since I was 21 but numbers are off again, need to readjust meds), as well as a few other problems (hypertension) associated with my super morbid obesity (God, that just sounds depressing :-( ), I started wondering if I might be able to apply for SSDI? If so, it would allow me to be able to have my DS surgery and dedicate myself to recovery and weight-loss (to rid myself of all these co-morbidities) without the added stress of if I will be able to work through the recovery or not.
If you have applied, what is the process and time-table and were you approved?
I have no idea if this is even a valid avenue to go down but I'm having a hard time finding info at the SS website to help me figure it out.
Denise
So I'm reading up on the BCBS requirements for the surgery, and it says 6 month physician-led weight loss has to be documented. It must be a MD, and not the bariatrician. Did you go through your PCP, or did you go through a different physician-led weight loss clinic? Did you do the WW/Jenny Craig thing where you did 3 visits in the 6 months?
I want to start this right away as I'm ready and rearing to go. I know my specific insurance plan through BCBS of Alabama PPO does cover it at 75%, and I went to the conference hosted by the surgeon, so I just want to know where to go from here. The bariatric surgeon's office will call today to set up an appointment, so I'm definitely going to do that, but I didn't know what other people's experiences were with BCBS and the 6-month diet requirement. I know insurance doesn't cover the 6-month supervised diet, so I'm okay with that.
I'd like to know some individual experiences. I have a BMI between 39-41 (it changes week to week regardless of what I eat), hypertension, high cholesterol, hypothyroidism, and anemia, so I know I qualify. I would like to know some similar experiences with BCBS and their 6 month diet.
Thanks!
Hang in there. This is all so typical. Get them what they want and if it needs to be faxed 10x before they say they rcvd it then make sure it's faxed 11x! Hopefully that's all they need and they'll approve you.