BCBS of IL requirements vs Surgon's requirements

(deactivated member)
on 3/19/15 2:48 am
with

So after confirming on more than one occasion with my insurance provider and receiving a written policy on WLS I do not require pre-op nutrition visits or weightloss.  My surgeon is the only one that is part of the BCBS approved network providers in my area and he requires minimum of 3 months dieting prior.  I'm extremely frustrated because the company I work for is not financially stable and I may end up without a job or insurance after having already done the pre-op testing and psych eval.  Is there anything I can do if it's surgeon vs insurance?  I don't know why the extra hoops? Anyone else deal with this?

poet_kelly
on 3/19/15 3:51 am - OH

You can ask your surgeon why the "extra hoops."  I assume because he wants to make sure you've tried losing weight by dieting before doing surgery and because your surgery will be safer if you lose some weight prior.  but ask him.

You can ask him to waive his requirement but he might not agree to do that.  In which case your choices are to find another surgeon or to comply with his requirements.

View more of my photos at ObesityHelp.com          Kelly

Please note: I AM NOT A DOCTOR.  If you want medical advice, talk to your doctor.  Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me.  If you want to know what your surgeon thinks, then ask him or her.    Check out my blog.

 

Valerie G.
on 3/20/15 12:33 am - Northwest Mountains, GA

I had a similar argument with my surgeon's staff.  She thought she 'knew it all' and was absolutely certain I would never be approved without it.  I insisted that she submit for approval, and if it was declined because I didn't do a 3 month diet, she would hear not a peep of complaint from me.  Is the nutritionist in their office?  If so - they may just want you to start on the right foot.  If you are to find your own- then it may be another "know-it-all" assumption. 

It's okay to challenge what they think they know.  Each policy is different.

Valerie
DS 2005

There is room on this earth for all of God's creatures..
next to the mashed potatoes

(deactivated member)
on 3/20/15 12:37 am
with

Thanks everyone, the nutrionist is within the surgeons office (center for weight loss).  I keep telling myself that they are only trying to set me up for success but the anxiety and worry that it could all fall through at the hands of my employer is worrisome. Just praying it all works out and everything is for a reason. Surgery can't come soon enough!

Tracasa
on 3/23/15 11:16 am

I don't know your situation but if you are extremely overweight your surgeon is taking precaution regarding your health. I had BCBS and since I had other health issues and wasn't considered heavy weight I was put on "fast track" but did have to meet with nutrition department and had to pre diet to help shrink liver. I know your excited to start this journey but everything that is required is to ensure your health and safety before during and after.  Talk to your surgeon again and explain your situation. 

                    
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