:'( What now???

So Tuesday I had my last appointment that I was told was required prior to surgery.  I got my surgery clearance from the bariatric office and was told they would submit my information to insurance the next day.  They said it would take 2-3 weeks to hear back then they would schedule my surgery.  

Well...I never trust them to do things when they say so I called today to verify that they had in fact submitted the information to insurance.  They said they hadn't because my insurance policy had changed and now says that I now have to have 12 months prior management of obesity. 

Needless to say I am FREAKING OUT.  I thought I was having surgery in a little over a month and now it seems it may be almost a year???  They can't seem to tell me what exactly is required now.  I tried calling insurance but was transferred to about 4 different people before getting disconnected and having to go back to work. 

I looked up on BCBS and found the following:

Under Benefits Application section, added statements "Benefits are provided for surgical treatment of morbid obesity (bariatric surgery) if the individual has received 12 consecutive months of medical management of this condition prior to the surgical procedure. Medical management is defined as participation in non-surgical weight reduction programs that include frequent, e.g., monthly, documentation of weight, dietary regimen, and exercise." Notification given 10/25/2016 for policy effective date 12/30/16.

To me this above sounds like I am screwed and it will be another year before surgery.

But then I found this....

Specialty Matched Consultant Advisory Panel review 11/2016. Under Benefits Application section, added statements "Benefits are provided for surgical treatment of morbid obesity (bariatric surgery) if the individual has a BMI ? 40 or BMI ? and has a significant comorbid condition including but not limited to diabetes mellitus, hypertension, sleep apnea, hyperlipidemia, severe osteoarthritis, metabolic syndrome, NASH etc., and has demonstrated evidence of attempts to lose weight through non-surgical means. These methods include follow up with medical provider for weight related comorbid conditions, and/or behavioral counseling, and/or nutritional counseling and/or physical activity through a professional qualified to provide these services or through a proprietary weight loss program. Please refer to the section below "When Surgery for Morbid Obesity is covered" and "Policy Guidelines" for detailed medical necessity criteria. "Judgement regarding the scope, depth, and adequacy of pre-surgical treatment during the 12 months prior to surgery is at the discretion of the multidisciplinary weight loss surgery team, and BCBSNC does not specify the content of the treatment.." Notification given 10/25/2016 for policy effective date 1/1/2017.

What should I do now? Am I screwed and have to jump through the new hoops?  I started the bariatric program in December so could that help me?  IDK Please I need some advice I am very very upset right now and don't know which direction to turn.  

I would call the clinic. They are used to dealing with these insurance companies. Maybe they can tell you. I'm sorry. We have BCBS. They were covering procedures wn I started my process March of last year. By the time I started the pre op stuff in June, they decided they would no longer cover dependent a (it's through my husband's job). The only way I got my surgery is because we just so happened to sell our home in June. We had some money set aside for some much needed remodeling. My husband agreed to the surgery instead. So I got my surgery and kept my 70s orange kitchen with no dishwasher. We never would have been able to afford it otherwise. 

All that orange and brown. It was a dark time.

We had orange wall to wall carpeting in our living room and couches with a large brown plaid.

sounds like our family room in that era.  Orange shag carpeting and a couch with a large brown plaid.  Plus cheap paneling on the walls.  Ugh!

Got to have the paneling. Our home was a symphony of blue. Blue shag, blue regular carpet, blue flocked wallpaper in the entry(fancy!) and that cheap ass paneling.

we had blue carpeting in most of the rest of our house.  It was a pretty shade of blue (and thankfully, not shag), but I swear I haven't seen blue carpeting (or any non-neutral shades) in years!  And wallpaper - does anyone wallpaper anymore??  That cheap 70s paneling was horrendous.  I don't know what people were thinking...  Plus it makes the rooms look so dark!!

My living room exactly!

I hope this helps a bit... the second page helpful tips is particular good to have when speaking with the reps over the phone http://www.obesityaction.org/educational-resources/brochures -and-guides/oac-insurance-guide 

Don't give up without a fight. 

Can you get a PCP to sign documentation that you have been trying to lose weight for the past 12 months?