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Boston Redhead

BCBS NC approval question from newbie

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Hi everyone!

So long story short: my company will be closing in February and I could be laid off anytime between now and then. I’ve been thinking about WLS for awhile, but now I need to have it sooner rather than later so it’s covered, plus if there are any post op complications, they’ll be covered too.

Unfortunately, one of the insurance requirements is:

  1. The individual must have serially documented active participation in a non-surgical weight reduction regimen for at least 6 continuous months, in the 2 years prior to surgery, to enable both behavioral changes and adequate assessment of anticipated postoperative dietary maintenance. These efforts must be fully appraised and documented by the physician requesting authorization for surgery; 

Of course, I see my PCP every six months and she records my weight and tells me I need to lose weight, but that’s the extent of my documentation. 

Any ideas or advice on what, if anything, I can do?

Thanks in advance! I’ve been lurking for awhile and appreciate the wealth of info in these forums.

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Oof. Yeah. For me, I had to do that for 3 months and it was documented by the weight loss clinic I went to. It sounds like you may not have that long. However, you could get started anyway and then you would have it partially done if your next insurance policy has the same requirement. If you have a WLS surgeon/clinic in mind, you may ask to speak with their insurance/financing office and see what they recommend. 

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Yeah I’m always late to the party! Hopefully I’ll have a new job right away but if not, I might not have insurance for awhile....

Good idea though. I’ll give them a call. Thanks!

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