Question:
BCBS of Ill. Applied for approval. This was their response.

In order to finalize your request we would appreciate some additional information from you. Please submit Medical policy requires documenttion of 6 months clinically supervised weight loss program, You submitted 3 months. I submitted 3 months. Do you thinkd it sounds promising if I submit my next 3 months. I am so nervous. Really wanting to get approved.    — pugsley101 (posted on August 4, 2008)

August 4, 2008
This is the same boat I am in. I have already 3 months completed so I go in tomorrow, then once in September and once in early October then they will re-submit to insurance. Originally the policy stated that Weight Watchers was suitable for supervised weight loss but then they came back and said no. I think they said no to the WW because all they do is weigh you in, they want somethign more personalized so I am seeing the nutritionist at my surgeon's office once a month. I am also seeing the physical therapist tomorrow so they have documentation that I have been educated regarding exercise. I am going to finish up my 6 months and see if they approve me. To me their response to you sounds promising, but just make sure that the documentation submitted is detailed in nature and shows you stuck to the program that whoever you saw put you on. My biggest fear is if I lose weight while on the 6 months program, will they come back and say well you lost on your own, why do you need surgery? Thats what I worry about the most. Have you been asked to keep a food journal? If you want to email me personally I can send you a copy of my denial letter which gives more info on what they are looking for.
   — jenbn

August 4, 2008
Many insurance companies have this policy. Mine did too. The insurance companies want to make sure you've made a documented attempt to lose wt on your own. I had surgery in 2006, and had to submit some proof within the previous 5 years of a wt loss program of at least 6 months duration. I had done a program in 2002, got a note from the wt loss office rep, and submitted that. Otherwise, I would have had to participat in what my insurance company calls the Options Program, where you learn about nutrition while you use Optifast to lose wt. I still had to do the nutrition classes, but no diet program--just recommended that we try to lose some wt on our own. DAVE
   — Dave Chambers

August 4, 2008
I had BCBS of PA. I had to be supervised with weight loss program for 6 months, my last month i gained 8 pounds and she submitted my paper work even though she said she was unsure what would happen because of the weight I gained, that made me very nervous, but got approved within the week. Boy what load off my mind. Had surgery July 22nd 08. Sue
   — [Deactivated Member]

August 4, 2008
I HAVE BCBS OF IL. AND THIS IS THEIR STANDARD MEATHOD. JUST GIVE THEM THE ADDITIONAL 3 MONTHS RECORDS AND THEY SHOULD APPROVE YOU AS THEY DID ME.
   — rrwirz

August 5, 2008
I have BCBS of Ill. It took me a year to get approved and despite having been through many diets and years of doctoring for weight loss, I actually had to go through the 6 mos of medically supervised dieting during that year. I hope you have an easier time getting approved than I did. It was worth it!! I am 5 mos post op and have lost almost 100 pounds. I feel SO GOOD.
   — Fluffee

August 6, 2008
I have BCBS insurance and I didn't have any problems getting approved. I have to send documents from my primary doctor with my weight for the past 6 years and as soon as I gave them all of my information I was approved within 2 days. I was so happy. I had my surgery May 30, 2008. It has been the best days of my life. Good luck with your insurance.
   — Angie NC

August 6, 2008
I have BCBS IL and I had to do the full 6 months as well. Make sure your dietian includes ALL the changes you have made and everything you have done. Mine was denied first time around even after 6 months. But...thankfully dietian wrote a letter and it was approved. I am 6 weeks post-op and surgery was paid for. Good Luck
   — shackett0426