Question:
BC/BS of IL- Only completed 4 months supervised weight-loss program

I had completed 4 months of a supervised weight-loss program about 18 months ago. Since the insurance company is wanting 6 months, will I only have to complete 2 more months, or will I have to start over?    — Suzanne C. (posted on February 13, 2009)

February 13, 2009
You will need to start over. It has to be 6 consecutive months in a row. Be sure that you discuss with your Dr. your daily diet, exercise and behavior modification and changes that are being made in each area for each visit-Ex: Your exercise should be increasing each month even its only by 10 minutes more. GOOD LUCK!!
   — [Deactivated Member]

February 13, 2009
Hi...I too have BCBS. My policy stated that I needed to have 6 consecutive months of a Doctor supervised weight loss program. At first I just wanted to get the surgery and move on, but now I am grateful that they made me wait. I was able to research more, learn as much about the band as possible, and prepare myself for my new life. I also challenged myself to loose 20lbs before surgery. The only prerequisite BC has was not to gain any more than 5lbs. I was worried if I dropped weight they would drop me. My BMI was just 35. Please understand I remember the feeling of frustration...knowing I had to go on ANOTHER diet. I went to the initial seminar in July and was approved Jan 5th. We submitted Jan 2nd to BC. Give yourself this 6 months, practice chewing, chewing, chewing. Good Luck and God Bless. Kimberly
   — kfgates

February 13, 2009
Depends on your insurance. Most are 6 months continually without missing a month within the last 2 years. I was sent by Dr.to dietitian and she required me to list 3 days of foods, drink, nd just what exercise I did like walking. Dr was every month continually also just for weigh in and etc., other things while I was there. Some Insurances are very sticky However, it also weeds out those who really think this is quick fix or not mentally ready for this or gives one time to really think about what a life time commitment this is. It is as much work now as it will be after. YOU have to do your part in working at exercise n changing your way of eating for your own good the rest of your life. Going to a psychiatrics for evaluation and testing also. Choosing the right doctor is as important. I went to Bridges Center. com. They make you very aware of what you must do and must attend seminars and they have their way of helping you understand a healthy way of eating. They map it all out give you much material. Tell you exactly what to eat during the first 6 weeks and afterwards, than up to you to either want this way of living. They tell your WHY you should eat this or that and Tell you what will happen to you if you don't. This is Tool that will help you reach your goal but YOU must follow the rules. I see so often some ask questions on this site, that even before surgery these questions are asked and answered either at the seminars or one can call and ask at the Bridges center. But I guess each Dr. or place has their own way of doing things ...I am glad I made the right choice as to whom I chose to have surgery with. Good luck and hope this information has helped.
   — Eneleh

February 13, 2009
I have BCBSIL however, I found out that even though my insurance is with them through my company, that my company has a set of requirements that they have to follow instead of theirs. My companies requirements to have the surgery were alot less strict than BCBSIL so it was alot easier and faster to get approved (1 week). I had to have a BMI 35 or over for more than a year, be over 18, show I had talked to a surgeon, psycholigist, and nutritionist and knew about all the risks and expectations of life changes, and had to have 2 of the following: high blood pressure, high cholesterol, heart problems/sleep apnea, type 2 diabetes, or immobility due to joint pain. I had everything but the diabetes and immobility. They rejected it the first time (took 1 day) but they used their criteria not my companies but once I pointed that out to them they re-submitted it and it only took another couple of days to get the approval. So you may want to check and see if your company has a set of requirements they need to go by they may be easier. I had no idea until I was talking to someone in one of our other plants in N.C. and she told me. Its worth a look! Hope this helps. Keep on trying and never give up! It will all work out for you. Keep me posted! Hugs...Donna
   — gonnabethinfinally

February 13, 2009
I too have BCBS/IL, a PPO plan. There are many variations on these plans and like the previous poster said your employer can set criteria too. Probably best to call the insurance co and talk to your HR dept and get specifics. That said, my plan also required 6 mo. consecutive supervised diet. I also had to document my exercise and behavior modifications throughout the 6 months, a one-on-one meeting with a nutritionist and obtain & pass a psyche evaluation. Yes, it's all frustratimg to those of us who have dieted, lost & gained repeatedly, at least I was in the beginning, but now that I'm at the end & in the submission process for RNY I am so thankful because I feel totally empowered with so much more knowledge about my upcoming lifestyle change. Hopefully your 6-mo pre-op diet will provide you the same benefits. You can NEVER know too much about this life-altering surgery no matter what type of WLS you have. Good luck and stay the course to a healthier life!
   — Arkin10

February 13, 2009
you will have to start over -- 6 continuous months -- one appointment ever 30 days is what they want -- good luck
   — RCassety

February 14, 2009
I would recommend calling your insurance company and talk to the rep about what criteria must be met, and then ask them to mail you a copy of the criteria needed for approval so you can really study it and make sure YOU know what you need and keep track of it over the six months you're working with the dietician/surgeon. Nobody is as interested in your approval for surgery as you are! Mine required 6 months TOTAL (Highmark BCBS through the United Transportation Union), but it could have been broken down into two, 3-month diets (3 months WeightWatchers, 3 months supervised diet with a physician, 3 months proof of NutriSystem, etc.) However, whatever diets I had participated in had to be within the last two years. I had two months here, two months there, two months over yonder, etc., so I had to do the full six months with my surgeon/dietician, which, truthfully, I'm glad I did. It gave me plenty of time to prepare and really learn about food and how it works with my body. One piece of advice is if you are required to follow a documented diet and exercise program, but your 6 months consists of primarily working with a dietician, make sure the notes from the dietician regarding your exercise will fulfill the exercise portion of the requirement, and that the dietician is making notes regarding exercise in each monthly report. Six months isn't so bad, but to find out in month seven that you aren't approved because you haven't met the exercise requirement would be quite unpleasant!
   — wenniewo