Question:
Where does bcbs ppo get there criteria for wls from ,how can i get a copy?

I have bcbs fl ppo blue choice I was told I have to be on a supervised diet for 12 months ,thyroid test ,psych.eval., letter of suport from pcp I have all except recent supervised diet it goes back approx. 7 yrs I have been on recent one but only for the past 8 months anyway I was just wondering how come I dont have a copy of what they want in their criteria anywhere in the benefits book all its says is that wls is covered as long as i havent had wls before. I sent in for my approval and trying to get the pre- existing waived because i had no pre existing condition they are in the process of that but now they are also saying that they want a letter from my cardiologist supporting wls all he wrote before was that he thought i should be on weight lost program but I submitted that myself the ins. never asked for it from the begining,Did anyone else ever maintain wls proof of criteria from their insurer when their wasnt any in benefits book? thanks for any help....    — marie M. (posted on April 2, 2003)

April 2, 2003
Hi I have Anthem BCBS ppo. I did NOT have 12 consecutive months and what I did have was a few months here and a few weeks there. But it was documented. Basically if your PCP. surgeon deems this medically nec. they should approve. They will make you nuts with all the info but DON'T give up.
   — Jamie M.

April 2, 2003
I also have BCBS PPO. I decided to take it upon myself to contact my insurance company so that I could possibly get the ball rolling before my June consult. I read my benefits book inside and out and there was nothing specific. Upon calling them, I could only find out that WLS is a covered service, my surgeon is in network, but as far as specifics I was told that it is an internal policy and my surgeon would have to contact them for details. Go figure!?!
   — Rhonda Y.

April 2, 2003
I listed all my diets for like the 11 yrs and half of them were not supervised and i was approved...do all the diets and years u have dieted and explain what was supervised and what wasnt if you told your doctor u were dieting and basically he monitored ur weight it was considered supervised i beleive. good luck hon
   — Deanna Wise

April 3, 2003
I have BCBSIL. When I called about the surgery I told me it was up to your policy how the procedure was covered. They sent me aand my doctor a copy of the requirements from our policy.
   — plucmn