BCBS dropps supervised diet requirement. - Page 2 - ThinnerTimes - Gastric Bypass Forum, Lap Band Forum, and Vertical Sleeve Gastrectomy Forum

momgreen · 09-21-2009, 11:33 PM

I also have BCBS PPO of Cali. I was not required to do a supervised diet, nor did I have to show proof of past failed weightloss attempts. All they required was a psych eval, nut consult, BMI 35 with 1 co-morbidity, or 40 BMI. This just goes to show you how very different the plans are, even within the same insurance company.

Lyndasline · 09-23-2009, 01:42 PM

now the only criteria is the BMI (35 + co_morbids) (over 40)
and a letter of medical necessity, and a psych eval.

I also just started this whole process and thought I'd have to do the diet thing for 6 months.... but she is right... no diet requrment any more! I am glad about this... but things are going REALLY quick.... which is starting to make me nervous! My next 2 apts are this next week, then schedual the surgry. (Should be anywhere from Oct-Dec.) I am ready... but...... Lynn

mlwberger · 09-23-2009, 06:21 PM

OMG...I have BCBS Texas...I wonder if that applies to me also? I am scheduled for surgery on October 6th.

Lyndasline · 09-23-2009, 06:32 PM

Yours is right around the corner anyway.... I don't know if all BS/BC have the new rules. Mine is through AZ and is a "xbp". (with the 1000 dollar plus decutable for payment)

mlwberger · 09-23-2009, 06:37 PM

Man...I am going to call tomorrow and find out for sure. I already paid for the procedure...but maybe the insurance will pay something. I found out that I am a BMI of 40, thought it was only 39, with borderline diabetes and increased blood pressure.

MissKeaton · 09-23-2009, 09:31 PM

mlwberger im sure if you are this close to surgery you should have already done everything and they would have told you if you needed another 6 months of dieting, that would suck if you go in for surgery in 2 weeks and come back with just a diet.

samtherockstar85 · 09-28-2009, 03:17 PM

Quote:

Originally Posted by momgreen

I also have BCBS PPO of Cali. I was not required to do a supervised diet, nor did I have to show proof of past failed weightloss attempts. All they required was a psych eval, nut consult, BMI 35 with 1 co-morbidity, or 40 BMI. This just goes to show you how very different the plans are, even within the same insurance company.

I agree. I have High Mark Blue Shield PPO, a Blue Cross plan out of Pennsylvania, (but I live in Michigan) and I need a psych eval, letter of medical necessity, and 6 month supervised diet. Also have the standard BMIs and such...

Every plan is different.

laurajh · 09-29-2009, 07:55 AM

Quote:

Originally Posted by chtinkham06

I just received a packet o' info from Blue Cross Blue Shield, about the criteria for WLS and they no longer require a medically supervised diet.

You don’t want to get peoples’ hopes up, so you should mention BCBS of what state you have coverage with, because this doesn’t apply to BCBS across the board.

I have BCBS of MN, and not only do they require the 6 month diet, they very specifically want to see certain notations made by my PCP. Just “yep she showed up and weighs this much this month” won’t cut it, they want to see the doctor making specific suggestions and me complying with them.

SLRteach · 10-02-2009, 09:38 AM

I have BC/BS of PA Direct Blue and they have NOT dropped the 6 month suprervised diet. I am on month 2 in Oct. I called to check this morning and the girl I spoke with said it varies from state to state.

Bummer!!! I look at it this way...This gives me more time to wrap my head around what is going to happen to me and how I am going to have to learn to change all the bad eating habits! I have my Nut and Psych eval this month too!

Anxious to hear what they have to say!

Still not 100% sure that I should have WLS, but love seeing and hearing about all the success stories.

gooberific · 10-02-2009, 11:19 AM

Not all BCBS plans are the same. My hubby's old BCBS insurance covered RNY and LapBand, but had a high copay and didn't cover VSG. This was Anthem BCBS of MO. We had a $1000 individual deductible and $2500 family.

My Federal Employee Program BCBS of AZ has a $300 deductible, covers VSG, RNY and LapBand, and has a 90/10 coinsurance payment policy. They did not require the 6 month diet, but I did 3 months to "satisfy" my secondary insurance -- who didn't even cover VSG, but paid my 10% share on surgeon's fees and anesthesia so I can't complain... but I think at least a couple months of supervised diet is helpful to "retrain" your brain.