Question:
Has anyone with BC/BS gotten approved without doing six month pre-op diet?
I just wanted to know if there were any loop holes. I have almost 10yrs. super morbide-obiese history with my pcp, doesn't that count for something!!! — slcompton (posted on October 27, 2008)
October 27, 2008
I have Anthem Blue Cross Blue Shield and they did not require 6 month
pre-op diet.
— Billie R.
October 27, 2008
I have the Empire Plan with BC/BS for hospitalization and United Health
Care for medical. I did not have to do the 6 month pre-op diet.
— gerrifei
October 27, 2008
There are exceptions to every rule but there is no way to say for sure. You
can not rely on what people on here have experienced since every insurance
policy is different even among the same carrier. Your best bet is to call
your carrier and ask them what the requirements are. Again, since each
policy is different, it may not matter how long you have been "super
morbidly obese" and you may have to follow thru with the supervised
diet no matter what. I was not required to complete a supervised diet when
I had my surgery covered under Horizon BCBS and neither was my husband but
that was just because our policy did not require it. I personally know
other people who are covered under Horizon BCBS and they not only had to
complete the diet but also a psych evalutaion and therapy for x amount of
time. It's on a case by case and policy by policy determination.
— [Deactivated Member]
October 27, 2008
I had BC/BS last year when I had my surgery. I didn't do the 6 months but
they accepted any doctor's visits within the last year where my weight was
taken. So I "sort of" skipped that step. Good luck to you.
— PAWLLA L.
October 27, 2008
nope, I had bcbs of PA and had to do the 6 months supervised diet, but time
went fast and i am already 3 months out. Good Luck.
— [Deactivated Member]
October 27, 2008
Honestly 6 months is not really all that long and will fly by like it's
nothing.. just any anyone on here. I am already almost 3 years out and it
seems like just yesterday I started the entire process.
— NavyNukeWife
October 27, 2008
If you can get approved in any way, shape or form with BCBS,
congratulations. I had BCBS of FL and all WLS was an absolute Plan
exclusion. I had to pay for all out of pocket. The fact that your PCP has
documentation of obesity should be very helpfull. Do you have any
co-morbids like HBP, diabetes, sleep apnea, etc??? That should help as
well. If your insurance requires a 6 month pre-op diet, there isn't really
anything you can do except play by there rules if you expect them to pay.
Best of luck,
Dawn V
— DawnVic
October 27, 2008
I have Horizon BC/BS and I too have to wait the 6 months because it is to
show that you have attempted a medically supervised weight lose program and
was not successful. That has been my experience and I just got that last
week so I have to do that for 6 months then it will be approved. I look at
it as I have had the weight all these years that 6 more months won't hurt
me.
— tazzytina34
October 27, 2008
I know it's hard to be patient. I am in the same boat as you. I had my
first appt with my PA in Sept and also saw her in Oct. I am seeing a nut
in two weeks, so that is already 3 months down. Once you start the
process there is lots to do and tests to take, etc., so you will have
things to do while you wait. Good luck!
— ajordan
October 27, 2008
i have bc/bs and had to do the 6 mo. my company changed insurance
companies after 3 mo of my 4 mo and i had to tack the extra months on for
them. it did stink!!!
— peggy R.
October 27, 2008
I have bc/bs hmo of Illinois. I did not have the 6 month wait. I was
appoved in 1 week. Good Luck!!!
— savoy7658
October 27, 2008
Blue Cross of Mass didn't require a 6 month diet. Good luck.
— hannahsmom1014
October 27, 2008
I have BCBS, and I actually got it JUST to have the surgery. My husbands
insurance did not cover GBS. I stated my process in January and had my
surgery on April 7th and that was after having to deal with a previous
hiatal hernia surgery. We had to make sure it could be done with a bunch of
tests.
So, my answer is NO... I did not have to do any pre-diets. I have an
excellent PCP who documented all of my weight issues. I would check and see
why they are requiring the 6 months. Maybe they didn't get all the
paperwork from your PCP. What State are you in?
— imaswtgrl
October 27, 2008
I have BCBS of Texas and like other readers it go by really fast but you do
have to do a 6month diet. All that is is just and adjustment because you
can't change the way you eat overnight. It is a major difference. I was
approved @ 4months.
— rena27
October 27, 2008
It really depends on your policy, what your extinuating circumstances are.
Now... I had to do the 6 month thing, but I was referred to a different
doctor by my surgeon to do this. He was awesome, and is my new PCP. I
would talk to the BCBS and to your surgeon. Their office will be
knowledgable about appeasing your insurance company.
I did also have to see the nutritionist and psychologist and have a sleep
study. Bonus was... I started at the first of the year. By the time that
my sleep study crap was over, my deductible was covered and a good chunk of
my out of pocket. (By the way, I have over 20years obesity). Be patient,
and calm.
My advice if the 6 month diet is inevitable, get it over with. See if your
surgeon works with another doc for the 6 month thing. Some do that are
able to word the paperwork just the way that insurance needs to see it.
Good luck and God bless!
— cassi75474
October 27, 2008
Every plan is different so I would call your Insurance Company and ask
specifically what is required for you. I had tried WW within the last 12
months for six months. My PCP just signed the weight log from there.
There are also forms I received from the nut that the PCP filled out to
cover a six month period that discussed weight loss attempts, exercise
attempts, goals for the next month, weight, what type of diet I was
following. If you have a history with your PCP he may be able to do
something like that for you.
— tonitoot
October 27, 2008
I have BC/BS POS and didn't have to do the 6 month pre-diet. Once they
received all of the paperwork it only took them 3 weeks to approve!
— pattschiele
October 28, 2008
I have BC/BS of Mass--no 6months reqd and I was approved in less than 3
days after my surgeon's office submitted my documentation
— Jasmine130
October 28, 2008
I;ve got BC/BS State of Ne Mexico. No 6 month pre-op diet required, but all
insurances even within BC/BS differ.
— jujuprof
October 28, 2008
I have BC/BS of NC and I was approved after my first letter of approval was
submitted without doing the 6 month diet and exercise plan. I know of
others with BC/BS that did the same thing because the 6 month plan is not
part of our requirement.
I would suggest however checking with your specific company.
— RN2B2009
October 29, 2008
I have BC/BS Carefirst Fed Govt. I have diabetes and high blood pressure.
All I had to do was write a letter explaining my attempts at dieting and
explaining my diabetes history. I was approved in two weeks.
— lekennedy
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