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Thread: Question -Blue Cross & Blue Shield ?

  1. #1
    Gastric Sleeve Member tessa_ellis's Avatar
    I have had a gastric sleeve.
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    Tessa
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    11/21/2011
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    Dr. Trace Curry
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    Default Question -Blue Cross & Blue Shield ?

    Well, I completed my psych eval yesterday, met with the surgeon, dietician, and the lady who takes care of dealing with insurance approval. When I spoke with my insurance company last week (Blue Cross & Blue Shield) I was told that they didn't require a pre-surgery diet, yet the Insurance lady at the Surgeons office had me start a 6 month diet, the info she had on my insurance company said they require 6 months supervised before approval. So ? Has anyone else had this issue ? I told her what the insurance told me and she said to go ahead and start the diet, and she would clarify it, but now this stresses me out, that just pushes everything back 6 months for approval, and at the rate I was going I was looking forward to having surgery in the next few months, not next summer ! UGH ! I hope I am just getting worked up prematurely and that she will find out I don't have to have a supervised 6 month diet before approval.
    Another thing was that in the lobby I was speaking to a woman who had the LapBand surgery, and had the same insurance company as me, she said she originally was attempting to have the Sleeve Surgery, but at some point the insurance denied her because they wanted her BMI to be 50 or above..... They had originally told her it was covered but denied further into the process, I am praying I don't run into this my BMI is 46 - In the short of it I'm like everyone else, I want the surgery completed at quickly as possible, lets get on with it !!!!



  2. Gastric Sleeve Surgery With Weight Loss Agents
  3. #2
    Gastric Sleeve Member AmyLess's Avatar
    I have had a gastric sleeve.
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    09/07/2011
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    Dr. Stephen M. Clark
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    Default Re: Question -Blue Cross & Blue Shield ?

    It depends on the state. I was told by my insurance gal that I could be out 6 months and to start seeing my PCP every month to at least be weighed, so I did. I also started full-force dieting. There's nothing like losing weight to show that you're serious (and no, Insurance does not hold it against you. I was at 33 BMI when I had my surgery). I was told my 9 years of diet/weight logs helped. I had surgery 3 months and one day to the date I had my initial consult. I also lost more than 25lbs during that time, which made my surgery and recovery much easier.
    Starting weight 06-06-11: 215 36.9 BMI
    Weight at Surgery 09-07-11: 188 32.3 BMI
    Current Weight as of 05-15-12: 135<-- As of 145lbs No longer overweight!
    Goal: 120 <-- Ideal weight 20.6 BMI



  4. #3
    Gastric Sleeve Member Theresa's Avatar
    I have had a gastric sleeve.
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    Theresa
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    02/08/2012
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    Default Re: Question -Blue Cross & Blue Shield ?

    My insurance wants me to do the 6 months with the dietician too. At first I kind of felt like you do, but I'm kind of glad in a way. It give me time to transition into different eating habits and I think metally I will be more prepared to deal with the lifetime changes I will be making.


    8/25/11 first visit to Dr ...275
    2/08/12 day of surgery.....239
    2/22/12 2 wk. post op......225
    3/07/12 4 wk. post op......219
    3/21/12 6 wk. post op......214
    5/08/12 3 mo. post op......199
    7/11/12 5 mo. post op......188 (this month was a long stall!!)
    I ♥ my sleeve


  5. #4
    Rae
    Rae is offline
    Gastric Sleeve Member Rae's Avatar
    I have had a gastric sleeve.
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    Rae
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    Hoehn
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    Default Re: Question -Blue Cross & Blue Shield ?

    I called my insurance company three separate times and confirmed I did not have to do a pre-surgery diet. The doctors office said I had to because my insurance plan required it. The insurance plan is through my husband's employer who is self insured and once you determine you want to do WLS you have to go through a bariatric nurse case manager and they require the 6 months supervised diet through a doctor or some place like weight watchers that has it documented each month for six consecutive months within the last two years.

    Good luck!





  6. #5
    Gastric Sleeve Member tessa_ellis's Avatar
    I have had a gastric sleeve.
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    Tessa
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    11/21/2011
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    Dr. Trace Curry
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    Default Re: Question -Blue Cross & Blue Shield ?

    I don't mind doing the 6 month supervised diet at all, I look at it as a chance to start making some changes, AKA / Do away with Mt. Dew 1st ! Its just that I hate being put back 6 months.
    jane_vsg_ayla likes this.



  7. Gastric Sleeve Surgery With Weight Loss Agents
  8. #6
    Gastric Sleeve Member
    I have had a gastric sleeve.
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    Default Re: Question -Blue Cross & Blue Shield ?

    I have Blue Cross Blue Shield TX and they do require 6 months. In fact, when I started it was 3 and right in the middle they changed it to 6, and that was SUCH an emotional bummer! They also only require a BMI of thirtysomething--maybe 37? Or 35? Anyway mine didn't quite qualify but because I had comorbities (diabetes) they qualified me anyway. Do you have any medical conditions like high blood pressure or diabetes that are associated with being overweight?


  9. #7
    Gastric Sleeve Member Monica_Lynn's Avatar
    I have had a gastric sleeve.
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    Monica
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    09/28/2011
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    Dr. Rob Schuster
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    Default Re: Question -Blue Cross & Blue Shield ?

    And BCBSIL also requires the 6 months of supervised weight loss. Maybe the issue is the pre-surgery diet wording--that could be a communication error. While my insurance doesn't require pre-surgery diet (the surgeon does) they do want to see that you have tried for at least 6 months within the last 24 months to lose weight on your own under the supervision of a medical professional.
    dderight likes this.



  10. #8
    Gastric Sleeve Member wyyldnite's Avatar
    I have had a gastric sleeve.
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    Jenn
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    Alan Saber
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    Default Re: Question -Blue Cross & Blue Shield ?

    BC/BS of Ohio requires 6 months medically supervised diet and weightloss program. Make sure your doctor puts in all of their office notes that you talked about your diet and exercise so you don't end up doing additional visits. I'd suggest cutting yourself out the soda cold turkey now. Just from cutting sugars out of your diet for 30 days will make your stomach go down and you will drop a few pounds just from that.

  11. #9
    Gastric Sleeve Member
    I have had a gastric sleeve.
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    12/11/2012
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    Dr Myers at Rush Chicago
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    Default Re: Question -Blue Cross & Blue Shield ?

    I had the same problem thur the day before my surg it was discovered that the ins didn't approve my operation that was set for 10am fri i found out at 5 on thur my husband thought he was going to have to scrape me off the walls.....i cried and cried why wasn't approved cause i hadn't did the weigh ins for 6 mos and yes it did put me back the pressure to prove and lose weight those 6 mos is awful i know you will understand for me pressure me what do i want to do eat.....that being said.... I did it my paper work went in on fri 9-9-11 to bc/bs from the wonderful dietian who worked with me whatever you do don't gain a oz. Seriously i know you got to be compliant hummmmm no pressure there....i had a foot operation that went bad really bad i may need another operation so while i was in my 6 mo period i was sitting in a chair cause i could not walk or ex but every month i managed to give them 2 lb weight loss....n the dietian and my surg sidekick said that was wonderful considering my foot....think before you put anything in your mouth you are going to go through a really rough 6 months won't sugar coat it don't show loss give them a reason to reject you cause your not *******************************************compila nt******************************** i hate that word...you go!!!! If i can do it with a bum foot you can do it will pray for you good luck!
    donna1743 likes this.



  12. #10
    Gastric Sleeve Member AdrienneG's Avatar
    I have had a gastric sleeve.
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    Adrienne
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    Default Re: Question -Blue Cross & Blue Shield ?

    BCBS federal is only 3 months supervised weight loss and I have an excellent primary care physician that was familiar with the requirements and at each visit she documented everything appropriately. I've lost 53 lbs on my own so that may have met the "diet" requirement. Approval only took 3 days and I see the surgeon TOMORROW to finalize my procedure (switched from bypass to sleeve) and then I get my date. BCBS also approved at the level of bariatric surgery which includes Lap Band, sleeve and bypass (lapro and open) instead of each individual procedure. I know this is a bummer but hang in there!!!! P.S. take a look at your insurance company's benefits for CY 12 to be sure you don't get caught in the middle of different requirements
    jarnols likes this.


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  14. #11
    Gastric Sleeve Member tessa_ellis's Avatar
    I have had a gastric sleeve.
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    Tessa
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    11/21/2011
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    Dr. Trace Curry
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    Default Re: Question -Blue Cross & Blue Shield ?

    Oh My, thanks for all this information ! @ lilbiskets especially thanks because the insurance lady yesterday told me not to stress over the diet, that they just required 5% weight loss over the 6 months supervised diet, and that I only had to lose 13 lbs in 6 months, she actually said to me don't push yourself the whole point is to show that you have a hard time losing weight on your own, but definately have to make the 5%. I told my sister n law when we left that didn't make any sense. So, as of tomorrow I am cutting out POP first, and going to watch carb intake, I have only a couple Co-Morbities, Sleep Apnea, Polycystic Ovarian Syndrome, High Cholesterol. NO high blood pressure or Diabetes. I am hoping to hear from Surgeons office tomorrow to verify the qualifications for surgery, she is supposed to make sure I have to wait and do the 6 month supervised diet, which was officially logged as first weigh in yesterday, she said they set it up and it will actually get finished in 5 months using yesterday as first weight in. ? Who knows, boy I have a feeling this is going to be a roller coaster ride, guess I would rather find out now then when I was close to getting surgery covered, that would be so heartbreaking.
    Also, they went ahead and scheduled an Endoscopy for Oct. 14th, I haven't heard anyone else mention this ?? The surgeon said they put a scope down to check out whats going on with your stomach, so they don't get in there and run into any issues. If I have to wait 6 months would next month be too soon for a Scope ?? Thanks again for all the replies, I'm loving this site !~! Good Luck to All !
    donna1743 likes this.



  15. #12
    Gastric Sleeve Member
    I have had a gastric sleeve.
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    Dr. Jorge Leiva
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    Default Re: Question -Blue Cross & Blue Shield ?

    Anthem BCBS only required 3 months, but I had already had YEARS of documented attempts and they accepted that. I was sleeved exactly 1 month after my first consult with my surgeon.
    Jeni, wyyldnite and donna1743 like this.

  16. #13
    Gastric Sleeve Member kimfj2's Avatar
    I have had a gastric sleeve.
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    Kim
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    08/15/2011
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    Dr. Turton
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    Default Re: Question -Blue Cross & Blue Shield ?

    BCBS of AL required 6 months of supervised weight loss program DOCUMENTED in medical notes visits to your doctor during that time period. I thought that was going to trip me up, but I had done WW for just at 6 months and among all the drs I saw during that time period there was enough documentation to put it through. They didn't seem to care about my actual progress during that time. Just that I had attempted something... The insurance issues were the worst, most stressful aspect of this entire journey. In the end, I think I paid a $200 co-pay for the surgery itself.


    [url=http://www.TickerFactory.com/weight-loss/w7Svk7y/]

  17. #14
    Gastric Sleeve Member wyyldnite's Avatar
    I have had a gastric sleeve.
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    Jenn
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    09/21/2011
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    Alan Saber
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    Default Re: Question -Blue Cross & Blue Shield ?

    you should see an endocrinologist as well. i have pcos and i am on metformin and it has helped with regulating my cycles (actually giving me cycles again). many women who have pcos are insulin resistant (pre-diabetic) and it will also help towards your surgery. i just had my egd (scope) and it was a breeze. took 15 minutes. my surgery is on the 21st and going through what i went through with my insurance and just having enough time to research the surgery and ask my doctors questions should make the part of after surgery a breeze for me.

    def make sure you quit drinking pop and start drinking water or crystal light for now on. you will feel a world of difference.
    becca72 likes this.

  18. #15
    Gastric Sleeve Member Jeni's Avatar
    I have had a gastric sleeve.
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    Jennifer
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    Default Re: Question -Blue Cross & Blue Shield ?

    I'm in Michigan and I have Blue Care Network and had to do the 6 months diet. I was told here that the bcbs members don't have to do it.



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