BCBS

this is also in response to the pre op conversation
but i have a few questions, dont mind me i feel like an idiot when it comes to this, here i thought i read up and yet more things come my way anyone else have bcbs who may have some insight?
i just called my insurance company and they said that out of state doesnt really matter and for me not to worry about that, it will go as regular bcbs ppo. however she said there was a HUGE book she will mail out to me and 8 major regulations. she read them off to me, but as sweet as she was she was honest in telling me she didnt know much about what they meant and i will have to talk to my dr and when they send in the letter for approval we will find out then. they were normal criteria like -bmi over 40, or bmi over 35 with co morbities (im pretty sure im over 40...) -5 year duration of being over weight (i wrote this on my memo to my dr before the first appointment over a year ago, im not sure what proof they need, pictures?!) -no kidney or GI problems (i had my gallbladder out in 2006... i dont consider this a problem anymore... should i?) and then there was this one -1 or more rigorous attempts at weight loss equaling 6 months. now is this the 6 month pcp required diet everyones talking about needing for aetna? or is this having to do with the sheet i filled out letting them know what ive done in the past ie: weigh****chers, diet workshop, the gym, gall bladder surgery. etc.
also they said it depended on the type of surgery, rny, ds, vbg, and im sorry for sounding ignorant but i thought there was either lap band or gastric bypass (either open or laproscopically) any insight as to what these others are?
thanks again for all the help, i feel so stupid even though ive been trying to read up for a year i guess i didnt read enough?!?!

Hey There Darling, I have BCBS as well. I was sent not a book but a letter of criteria that has to be met prior to surgery. The 6 month diet in the pass four years is mandatory for BCBS. Some BCBS’s like mine will take a 6 month weigh****chers consecutive diet payment receipts or your membership book.   You don’t sound like an idiot at all. Insurance is a toughy for sure! Keep asking questions b/c it helps us all!

hey ok thats what i was wondering about the 6 month thing, see, i didnt have health insurance until i married my husband because we were living in utah and its hardly offered. now im in mass. i joined weigh****chers in a way, my friend joined and paid and then her mom gave her a membership to jenny craig or something and she decided she didnt want the ww anymore so i went as her, i know, i cheated the system, i can call about a gym membership and probably call for my gall bladder records but that could take a while. i did belong to curves, and i have the key card and the book, i belonged for a year and dishonest me noticed about 6 months through that they werent charging me, but i also had found out i was pregnant and needed all the money i could get so i just stopped going. i could get a letter from my pcp saying ive been overweight since going there but she's new and ive only had her about 6 months and ive only seen her for 2 ear infections and one weight related. any suggestions as to what will work?!?!

Hi, I have BCBS of californai, they never said anything about the out of state problem and I'm having my surgery in nevada. As for your BMI you can calculate that online just search BMI. 5 years documentation of being over weight can be shown just by submitting your medical records to insurance since it will show your weight. Your suregons office will ask you to document when you attempted to lose weight ie.( weigh****chers, jenny craig ect.) along with the dates and how much you lost/ or gained. At least this is what mine did. Not all insurance compaines require the 6 month doctor monitered diet. There are several types of surgeries out there but lapband and rny are the most commonly done at this time. Hope that helps

I have BCBS as well and this is what I had too do (PS. It took 2 years of going back and fourth with insurance too have my surgery).

6-Month supervised diet with primary physician INCLUDING a daily food journal.

- A letter from your primary physician stating that you have tried diets in the past, prescription diet pills, and nothing has been helpful

- A personal letter from myself

- BMI of at least 35

- ANOTHER letter from your primary physician stating that I had been overweight for the past at least 5 years

Ypu will most likely have to wait another 6 months while you do your diet with your physician (unless you pay out of pocket). This means that you have to go and weigh in with your doc once a month, he/she has to recored it and send it in at the end to your insurance co.

They sure don't make it easy...but you gotta do what you gotta do.

Good luck!

I think everyone is or has been in your shoes. I am just glad to hear that some BCBS cover it. I have double cover with two different BCBS plans and the laughed at me when I call to see if I was covered. I am having to find financing at 20 for my surgery( thats another story).... But it actually is not that bad! a couple years back I did the monitored diet with my doctor and most of the surgeons will slightly work with you and tell the insurance companies what they want to hear to get approved a little faster.... just be sure you know exactly what they want I did all that just 2 be denied.... Good luck!