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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.
Never accept NO for an answer. 
Well what a surprise! I just received word today that I was denied because of missing paperwork. They said the psy eval wasn't submitted along with a letter from my PCP. I just spoke with the coordinator and she said the psy eval was included. I didn't know that I needed a letter from the PCP, it didn't state that in my coverage.
Now I have to get the letter from PCP which I just called to get and then the coordinator will appeal. More waiting!
VSG on 1/14/14 with Dr. Samuel Wasser
I'm keeping my fingers crossed and praying for both of us. I spoke to a representative today and it is still "under review." Ugh! I'm going to think positively though, at least they didn't take one look and reject it.
Height: 5'1" HW: 229 SW: 203 CW: 147.7
Mine was submitted to Aetna on Monday, October 14th and I'm still waiting. I don't know if that is good or bad. :-) It has been with Aetna's nurse for review since last Thursday so I'm keeping my fingers crossed. At least she didn't take one look and throw it out. I'm hoping this is a good sign.
Height: 5'1" HW: 229 SW: 203 CW: 147.7
Aetna is very picky. I tried submitting two years ago and they wouldn't approve until I had an additional 5 months doctor documented weight. I put my surgery off and I'm once again in the middle of the process. The dr's office called yesterday because Aetna was looking for my 2012 weight. I'm worried because my BMI was 39.7 as I was in the middle of a diet. I have documented weight for many years but they want 24 consecutive months. My fingers are crossed that they will approve.
I would submit and see what they say. If they say no, you can at least get them to tell you why so you will know for sure what you need going forward. Good luck! I hope it all works out for you.
Height: 5'1" HW: 229 SW: 203 CW: 147.7
I would try anything. Just send it in to see what they say. I know I had to send the last 2 years of weight as a requirement but
what do you have to loose. I am still waiting on approval myself. Hopefully sometime this week. Good Luck!
My paperwork was submitted on Oct 9th and I just called Cigna and it is still pending! She said that it normally takes about 15 days for approval!
VSG on 1/14/14 with Dr. Samuel Wasser
Hockeymom87 · 0 replies · 663 views
