BCBS-FL

??

I aslo have BCBS-NJ ppo and i did my 6months diet thing w my surgeon and he wrote a letter to them along w my pcp saying y i needed the surgery and also I go a copy from my ob-gyno of all my weight ins there because I was there more then my pcp to mail to the insurance company! And I got approved right away no decline! 

Hi

I have BCBS (Anthem) PPO with my employer and had NO issues getting approved.
Every state and emplyer is different, but here is the policy from anthem/bcbs

PMSURG.00024 Surgery for Clinically Severe Obesity   
Medically Necessary:
Position Statement

Gastric bypass and gastric restrictive procedures with a Roux-en-Y procedure up to 150 cm, laparoscopic
adjustable gastric banding (for example, the Lap-Band® System or the REALIZETM Adjustable Gastric Band), vertical banded gastroplasty, biliopancreatic bypass with duodenal switch, and sleeve gastrectomy (open or laparoscopic) are considered medically necessary for the treatment of clinically severe obesity for selected adults (18 years and older) who meet ALL the following criteria:

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, (e.g., severe 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..

Notice it says nothing about 6 months of diet..Just "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"

Best regards,

J

Thank you both so much! Every little bit of information helps.  We don't have a lot of time to get everything done and I am getting so nervous.  I would hate to get so close to the finish line and not cross it.

You all are very lucky.  Arkansas BCBS won't even touch it.